DHHS IHS Phoenix Area
Organization Active NPI Critical Access Hospital · Polacca, AZ
NPI 1356628028 · NPPES record last updated May 24, 2016
Key facts
- NPI
- 1356628028
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 366937 (AZ)
- Legal business name
- DHHS IHS PHOENIX AREA
- Practice address
- Highway 264 Milepost 388
Polacca, AZ 86042-4000 - Phone
- (928) 737-6000
- Fax
- (928) 737-6080
- NPI assigned
- Nov 9, 2011
- Organization subpart
- No
Authorized official
- Name
- Daryl Melvin
- Title
- Ceo
- Phone
- (928) 737-6010
Corporate family (same tax ID) 17
Practitioners 224
-
Mark Bailey, MD
-
Grant S Berges, MD
-
Benjamin Paul Coleman, D.O.
-
Erik Donald Cox, ENP-C, FNP-C
-
Gregory Ely, M.D.
-
Joan Ann Maceachen, M.D
-
Jerome John Rogich, MS, MD, DIMM
-
Janet Thurston, CNM, FNP
-
Kim E. Tranquada, M.D.
-
Sandeep Amesur, M.D.
-
David K Bass, MD
-
Troy Allyn Belle, MD
-
Angelique Mechelle Jackson, RN, APN-BC
-
Mohamed Azkar Jamaldeen, M.D.
-
Willie L Nunez, M.D.
-
Anna Rabkina, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ, TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120130000104 | AZ | Part a Provider - Indian Health Services Facility | 5698941466 | Practice locations: Polacca, AZ |
| O20120222000148 | TX | Part B Supplier - Clinic/Group Practice | 9436325420 |
Receives reassigned benefits from 202 practitioners Practice locations: Polacca, AZ |
National Provider Directory
- Tax ID family
- Phoenix Indian Med Cent
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker |
104100000X | |||
| Dentist |
122300000X | |||
| Nutritionist |
133N00000X | |||
| Optometrist |
152W00000X | |||
| Registered Nurse |
163W00000X | |||
| Emergency Medicine Physician |
207P00000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Podiatrist |
213E00000X | |||
| Critical Access Hospital | 282NC0060X | 366937 | AZ | Yes |
| Nurse Practitioner |
363L00000X | |||
| Clinical Nurse Specialist |
364S00000X |
Addresses
Primary practice location
Highway 264 Milepost 388
Polacca, AZ 86042-4000
Mailing address
Highway 264 Milepost 388
PO Box 4000
Polacca, AZ 86042-4000
Phone (928) 737-6000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 861717 | Medicaid | AZ | |
| 020529 | Medicaid | AZ |
Other names
- HOPI HEALTH CARE CENTER
Other providers in Polacca, AZ
- Emma Guadalupe Cortez
- Kiley Marissa Cox
- Tracy Denet
- Rocky Ray Deswood
- DHHS IHS Phoenix Area
- DHHS IHS Phoenix Area
- DHHS IHS Phoenix Area
- Alison Dion
- Barbara Dobbs
- Correena Lorraine Duckworth
All providers in Polacca, AZ · Critical Access Hospital in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 24, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.