NPIMap

Organization Active NPI

Mountain Park Health Center

  • Federally Qualified Health Center (FQHC)
  • Glendale, AZ
National Provider Identifier
1316637481
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAIN PARK HEALTH CENTER
Practice address
6975 W Glendale Ave
Glendale, AZ 85303
Phone
(602) 243-7277
NPI assigned
May 11, 2023
Last updated
May 11, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNTAIN PARK HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
John Swagert, MDNPI 1720047657
Title
Ceo
Phone
(602) 323-3470

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

6975 W Glendale Ave
Glendale, AZ 85303

Mailing address

3003 N Central Ave Ste 1600
Phoenix, AZ 85012-2908
Phone (602) 323-3344

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040119000460 AZ Part B Supplier - Clinic/Group Practice 8325949647 Receives reassigned benefits from 185 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Goodyear, AZ; Tempe, AZ; Phoneix, AZ; Phoenix, AZ; Glendale, AZ
O20230919002042 AZ Part A Provider - Federally Qualified Health Center (FQHC) 8325949647 Practice locations: Glendale, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316637481. Details of each certification follow.

Federally qualified health center certification: CCN 031020

Legal name
MOUNTAIN PARK HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 25, 2023
Last certification
Aug 25, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1980 in AZ
Enrollment address
6975 W Glendale Ave
Glendale, AZ 85303-2611

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Mountain Park Health CT11 organizations share this tax ID, including this one
Part of
Mountain Park Health CT

Other organizations with this tax ID 10

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

Locations

6975 W Glendale Ave
Glendale, AZ 85303
Phone (480) 729-0905

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGGEBA

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
John R Swagert Individual Corporate OfficerChief Executive Officer Jun 6, 2006
Corporate DirectorChief Executive Officer Jun 6, 2006
W-2 Managing EmployeeChief Executive Officer Jun 6, 2006
Daniel O'Brien Individual Corporate DirectorBoard Member Feb 25, 2025
Katherine Cecala Individual Corporate DirectorBoard Member Feb 25, 2025
Cheri Figueroa Individual Corporate DirectorBoard Member Feb 25, 2025
Morgan Johnson Individual Corporate DirectorBoard Member Feb 25, 2025
Wajeh Khan Individual Corporate DirectorBoard Member Feb 25, 2025
Michael Stewart Individual Corporate DirectorBoard Member Feb 25, 2025
Randolph Rody Individual Corporate DirectorBoard Member Feb 25, 2025
Marion E Harrison Individual Corporate DirectorBoard Member Feb 25, 2025
Richard Siever Individual Corporate DirectorBoard Member Feb 25, 2025
Anna Ortiz Individual Corporate DirectorBoard Member Feb 25, 2025
Page Underwood Individual Corporate DirectorBoard Member Feb 25, 2025

Owners & managing parties with NPI records 1

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

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": "1683763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1316637481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3003 N CENTRAL AVE STE 1600",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122908",
            "telephone_number": "602-323-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6975 W GLENDALE AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85303",
            "telephone_number": "602-243-7277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN PARK HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN PARK HEALTH CENTER",
        "enumeration_date": "2023-05-11",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "SWAGERT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-323-3470",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, AZ

Sources for this page

Verify at the official NPI Registry.