NPIMap

Organization Active NPI

Nevada Health Centers Inc.

  • Mobile Mammography Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1386944593
Registry record updated Jun 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mobile Mammography Clinic/CenterTaxonomy code 261QR0207X
License
03-54-3392-01 Issued in NV
Legal business name
NEVADA HEALTH CENTERS INC.
Practice address
1799 Mount Mariah Dr
Las Vegas, NV 89106-1501
Phone
(877) 581-6266
Fax
(702) 220-3679
NPI assigned
Oct 22, 2010
Organization subpart
No

Owned or controlled facilities with NPI records 14

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

View all 14

Other NPIs on the same Medicare enrollment 34

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

View all 34

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000452 NV Part B Supplier - Clinic/Group Practice 7113835307 Receives reassigned benefits from 65 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Virginia City, NV; West Wendover, NV; Amargosa Valley, NV; Austin, NV…
O20110211000136 NV Part A Provider - Federally Qualified Health Center (FQHC) 7113835307 Practice locations: Las Vegas, NV

Federally qualified health center certification: CCN 291840

Legal name
NEVADA HEALTH CENTERS INC
Doing business as
NEVADA HEALTH CENTERS MAMMOVAN
Organization structure
CorporationNon-profit
Incorporated
Oct 22, 1992 in NV
Enrollment address
1799 Mount Mariah Dr
Las Vegas, NV 89106-1501

All disclosed owners & managing parties 13

Medicare enrollment files

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

NameRoleSinceShare
Alan Herak Individual Corporate DirectorBoard Member Jul 1, 2023
Donald E Chaney Individual Corporate DirectorBoard Memeber Aug 1, 2012
Timothy Blakely Individual Corporate DirectorBoard Member Jun 1, 2018
Lyn Beggs Individual Corporate DirectorBoard Member Jun 1, 2022
Jeff Snyder Individual Corporate DirectorBoard Member Jun 1, 2017
Alicia Y Barnes Individual Corporate DirectorBoard Memeber Aug 1, 2012
Gerald Ackerman Individual Corporate DirectorBoard Member Mar 1, 2011
Tom Zumtobel Individual Corporate DirectorBoard Member Jun 1, 2022
Linda Bingaman Individual Corporate DirectorBoard Member May 15, 2015
Kathryn L Triplett Individual Corporate OfficerCfo Oct 1, 2016 100%
W-2 Managing EmployeeCfo Oct 1, 2016 100%
Maurice Washington Individual Corporate DirectorBoard Member May 15, 2015
Jared Carter Individual Corporate DirectorBoard Member Jun 5, 2009
Walter B Davis Individual Corporate OfficerCeo Nov 26, 2012 100%
W-2 Managing EmployeeCeo Nov 26, 2012 100%

All facility ownership & control disclosures 14

Medicare enrollment files

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

FacilityTypeRoleSince
Cambridge Family Health CenterLas Vegas, NV, CCN 291829 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013
North Las Vegas Family Health CenterNorth Las Vegas, NV, CCN 291824 Federally qualified health center Operational/Managerial Control (100%) May 3, 2013
Eastern Family Medical and Dental CenterLas Vegas, NV, CCN 291837 Federally qualified health center Operational/Managerial Control (100%) Jun 29, 2010
Jackpot Community Health CenterJackpot, NV, CCN 291823 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 1999
Henderson Family Health CenterHenderson, NV, CCN 291849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 18, 2015
Nevada Health Centers Carson City School BasedCarson City, NV, CCN 291854 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 21, 2015
Nevada Health Centers at Virginia CityVirginia City, NV, CCN 291855 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2015
Nevada Children'S Health ProjectLas Vegas, NV, CCN 291862 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2018
Nevada Health Centers at EnterpriseLas Vegas, NV, CCN 291863 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 10, 2019
Willow Street Health CenterReno, NV, CCN 291009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 22, 2023
Mobile Medical Services 1Carson City, NV, CCN 291010 Federally qualified health center 5% Or Greater Direct Ownership Interest Dec 29, 2023
Mobile Dental Services 1Elko, NV, CCN 291011 Federally qualified health center 5% Or Greater Indirect Ownership Interest Dec 1, 2023
Nellis Family Medical & Dental CenterLas Vegas, NV, CCN 291013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 9, 2024
Pahrump Family Health CenterPahrump, NV, CCN 291014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 8, 2024

National Provider Directory

National Provider Directory
Tax ID family
Nevada Rural Health Cen34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

NPPES NPI Registry

Updated by the provider on Jun 10, 2014

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

Authorized official

Name
Walter B Davis
Title
Ceo
Phone
(775) 888-6610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mobile Mammography Clinic/Center 261QR0207X 03-54-3392-01 NV Primary

Addresses

Primary practice location

1799 Mount Mariah Dr
Las Vegas, NV 89106-1501

Mailing address

3325 Research Way
Carson City, NV 89706-7913
Phone (775) 888-6610

Other identifiers 3

IdentifierTypeStateIssuer
1386944593MedicaidNV
03-54-3392-01OtherNVNEVADA RADIATION CONTROL PROGRAM REGISTRIATION
DQ468AOtherNVMEDICARE ID - TYPE UNSPECIFIED

Other names 1

  • Nevada Health Centers Mammovan Doing business as

NPI Registry JSON

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

{
    "created_epoch": "1287705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402358400000",
    "number": "1386944593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 RESEARCH WAY",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067913",
            "telephone_number": "775-888-6610",
            "fax_number": "775-888-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1799 MOUNT MARIAH DR",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891061501",
            "telephone_number": "877-581-6266",
            "fax_number": "702-220-3679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEVADA HEALTH CENTERS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-22",
        "last_updated": "2014-06-10",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "775-888-6610"
    },
    "taxonomies": [
        {
            "code": "261QR0207X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile Mammography",
            "state": "NV",
            "license": "03-54-3392-01",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386944593",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEVADA RADIATION CONTROL PROGRAM REGISTRIATION",
            "identifier": "03-54-3392-01",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID - TYPE UNSPECIFIED",
            "identifier": "DQ468A",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nevada Health Centers Mammovan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.