NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

Doing business as Parker Walk in Clinic

  • Rural Health Clinic/Center
  • Parker, AZ
National Provider Identifier
1316568595
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Doing business as
Parker Walk in Clinic
Practice address
601 W Riverside Dr Ste 2
Parker, AZ 85344-5119
Phone
(928) 256-4110
Fax
(928) 256-4112
NPI assigned
Apr 29, 2020
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN LUIS WALK-IN CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda Aguirre, RD
Title
President & Ceo
Phone
(928) 315-7910

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

601 W Riverside Dr Ste 2
Parker, AZ 85344-5119

Mailing address

PO Box 617
Somerton, AZ 85350-0617
Phone (928) 315-7910

Other names 1

  • PARKER WALK IN CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040514000795 AZ Part B Supplier - Clinic/Group Practice 2668361841 Receives reassigned benefits from 88 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somerton, AZ; Yuma, AZ; San Luis, AZ; Kingman, AZ; Parker, AZ; Lake Havasu City, AZ
O20200505001943 AZ Part A Provider - Rural Health Clinic 2668361841 2 other NPIs on this enrollment
Practice locations: Parker, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316568595. Details of each certification follow.

Rural health clinic certification: CCN 033843

Legal name
SAN LUIS WALK-IN CLINIC INC
Doing business as
PARKER WALK IN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 26, 2020
Last certification
Sep 1, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 2020 in AZ
Enrollment address
601 W Riverside Dr
Ste 2
Parker, AZ 85344

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory
Tax ID family
San Luis Walk-in Clinic Inc20 organizations share this tax ID, including this one
Part of
San Luis Walk-in Clinic Inc

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

601 W Riverside Dr
Ste 2
Parker, AZ 85344
Phone (928) 256-4110

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Howie Jorajuria Individual Corporate DirectorBoard Member Apr 1, 2020
Candice L Orduno Individual Corporate DirectorBoard Member Apr 1, 2020
Ron Clark Individual Corporate DirectorBoard Member Dec 19, 2024
Elizabeth Carpenter Individual Corporate DirectorBoard Member May 26, 2022
Amanda Aguirre Individual Corporate OfficerPresident & Ceo Apr 1, 2020
Victor Lozano Individual Corporate DirectorBoard Member Apr 1, 2020
Jason Bradley Individual Corporate DirectorBoard Member Apr 1, 2020
Marisol Penuelas Individual Corporate DirectorClinical Operations Director Jun 22, 2022
W-2 Managing EmployeeAd; Jun 22, 2022
Juan M Guerrero Individual Corporate DirectorBoard Member Apr 1, 2020
Augustus Matthew Kurupas Individual Corporate DirectorBoard Member Sep 19, 2024
Ryan Holt Individual Corporate DirectorBoard Member Sep 30, 2021
Eraclio Arvizu Individual Corporate DirectorBoard Member Apr 1, 2020

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
San Luis Walk-in Clinic IncSan Luis, AZ, CCN 033831 Rural health clinic Operational/Managerial Control (100%) May 1, 2003

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1316568595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853500617",
            "telephone_number": "928-315-7910",
            "fax_number": "928-722-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W RIVERSIDE DR STE 2",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853445119",
            "telephone_number": "928-256-4110",
            "fax_number": "928-256-4112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "enumeration_date": "2020-04-29",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "AGUIRRE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "928-315-7910",
        "authorized_official_credential": "RD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARKER WALK IN CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Parker, AZ

Sources for this page

Verify at the official NPI Registry.