NPIMap

Organization Active NPI

Mountain Park Health Center

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1386741668
Registry record updated Mar 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC 3514 Issued in AZ
Legal business name
MOUNTAIN PARK HEALTH CENTER
Practice address
3830 E Van Buren St
Phoenix, AZ 85008-6936
Phone
(602) 243-7277
Fax
(602) 286-0808
NPI assigned
Sep 20, 2006
Last updated
Mar 12, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNTAIN PARK HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 12, 2018

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

Authorized official

Name
Dr. John R Swagert, MDNPI 1720047657
Title
President and Ceo
Phone
(602) 323-3344

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 OTC 3514 AZ Primary

Addresses

Primary practice location

3830 E Van Buren St
Phoenix, AZ 85008-6936

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 AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040910000565 AZ Part A Provider - Federally Qualified Health Center (FQHC) 8325949647 Practice locations: Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386741668. Details of each certification follow.

Federally qualified health center certification: CCN 031842

Legal name
MOUNTAIN PARK HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 20, 2004
Last certification
Oct 20, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1980 in AZ
Enrollment address
3830 E Van Buren St
Phoenix, AZ 85008-6920

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
Mountain Park Health Center11 organizations share this tax ID, including this one
Part of
Mountain Park Health Center

Other organizations with this tax ID 10

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

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 Officer Jun 6, 2006
Corporate Director Jun 6, 2006
W-2 Managing EmployeeChief Executive Officer Jun 1, 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 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520812800000",
    "number": "1386741668",
    "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",
            "fax_number": "602-323-3496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 E VAN BUREN ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086936",
            "telephone_number": "602-243-7277",
            "fax_number": "602-286-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN PARK HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN PARK HEALTH CENTER",
        "enumeration_date": "2006-09-20",
        "last_updated": "2018-03-12",
        "status": "A",
        "authorized_official_last_name": "SWAGERT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "602-323-3344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC 3514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.