Mountain Park Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Tempe, AZ
NPI 1376640656 · NPPES record last updated Mar 12, 2018
Key facts
- NPI
- 1376640656
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- MOUNTAIN PARK HEALTH CENTER
- Practice address
- 1840 E Broadway Rd
Tempe, AZ 85282-1614 - Phone
- (602) 243-7277
- Fax
- (480) 927-1092
- NPI assigned
- Sep 20, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MOUNTAIN PARK HEALTH CENTER
Authorized official
- Name
- John R Swagert, MD
- Title
- Ceo
- Phone
- (602) 323-3242
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 10
Practitioners 117
-
Dana Leigh Allgood, FNP-C
-
Esther Apraku Bondzie, WHNP
-
Kya Nicole Armstrong, PA-C
-
Kyra Artise, RD
-
Delia Avelar, PSY.D.
-
Dalisa Barquero, ARNP
-
Supriya Bhandari, M.D.
-
Amanda Leeh Blackhorse, LMSW
-
Brittany Anne Brown, PSYD
-
Taylor Elizabeth Brown, WHNP-BC
-
Hampton Hope Butler, DNP
-
Olivia Cain, RD
-
Deborah Calhoun, NP-C
-
Destinee Amie Campbell, NDTR, RDN
-
Rachel Cassinat, MS, RD
-
Drew Cavanaugh, LCSW
-
Jena Chalmers, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Federally qualified health center certification: CCN 031850
- Legal name
- MOUNTAIN PARK HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Aug 14, 2006
- Last certification
- Aug 14, 2006
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 17, 1987 in AZ
- Enrollment address
- 1840 E Broadway Rd
Tempe, AZ 85282-1614
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| John R Swagert |
W-2 Managing Employee |
May 7, 2006 | |
| Daniel O'Brien |
Corporate Director |
Feb 25, 2025 | |
| Katherine Cecala |
Corporate Director |
Feb 25, 2025 | |
| Cheri Figueroa |
Corporate Director |
Feb 25, 2025 | |
| Morgan Johnson |
Corporate Director |
Feb 25, 2025 | |
| Wajeh Khan |
Corporate Director |
Feb 25, 2025 | |
| Michael Stewart |
Corporate Director |
Feb 25, 2025 | |
| Randolph Rody |
Corporate Director |
Feb 25, 2025 | |
| Marion E Harrison |
Corporate Director |
Feb 25, 2025 | |
| Richard Siever |
Corporate Director |
Feb 25, 2025 | |
| Anna Ortiz |
Corporate Director |
Feb 25, 2025 | |
| Page Underwood |
Corporate Director |
Feb 25, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100728001273 | AZ | Part a Provider - Federally Qualified Health Center (FQHC) | 8325949647 | Practice locations: Tempe, AZ |
National Provider Directory
- Tax ID family
- Mountain Park Health CT
- Part of
- Mountain Park Health CT
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | OTC 4015 | AZ | |
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1840 E Broadway Rd
Tempe, AZ 85282-1614
Mailing address
3003 N Central Ave Ste 1600
Phoenix, AZ 85012-2908
Phone (602) 323-3242
Other providers in Tempe, AZ
- Cheryl Lee Morton
- Sheri Denise Moser
- Juliana Mosher
- Valeria Motten
- Kamal F Moukabary
- Mountainside Fitness Acquisitions, LLC
- Nancy Mounteer
- Move Free Chiropratic PLLC
- Felicia Moya
- MPVP Psychiatry
All providers in Tempe, AZ · Federally Qualified Health Center (FQHC) in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 12, 2018. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.