NPIMap

Organization Active NPI

Family Medical Center PLLC

  • Rural Health Clinic/Center
  • Safford, AZ
National Provider Identifier
1417125444
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FAMILY MEDICAL CENTER PLLC
Practice address
1492 S 20TH Ave
Safford, AZ 85546-4052
Phone
(928) 348-2151
Fax
(928) 428-3617
NPI assigned
Feb 12, 2008
Last updated
Jan 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Dr. Joel G Wright, MDNPI 1821187303
Title
Doctor
Phone
(928) 348-2151

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1492 S 20TH Ave
Safford, AZ 85546-4052

Mailing address

1492 S 20TH Ave
Safford, AZ 85546-4052
Phone (928) 348-2151

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080530000208 AZ Part B Supplier - Clinic/Group Practice 8123198314 Receives reassigned benefits from 6 practitioners
Practice locations: Safford, AZ
O20210422003125 AZ Part A Provider - Rural Health Clinic 8123198314 Practice locations: Safford, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417125444. Details of each certification follow.

Rural health clinic certification: CCN 033848

Legal name
FAMILY MEDICAL CENTER PLLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 12, 2021
Last certification
Nov 12, 2021
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Jan 22, 2008 in AZ
Enrollment address
1492 S 20TH Ave
Safford, AZ 85546-4052

National Provider Directory

National Provider Directory

Locations

1492 S 20th Ave
Safford, AZ 85546
Phone (520) 348-2151

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Katerine Miller Individual W-2 Managing EmployeeOffice Manager Sep 8, 2025
Clinton D Damron Individual 5% Or Greater Direct Ownership Interest Jun 30, 2025 50%
Corporate DirectorMedical Director Jun 30, 2025
W-2 Managing EmployeeMedical Director Jun 30, 2025
Matthew R Sampson Individual 5% Or Greater Direct Ownership Interest Jun 30, 2025 50%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1202774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1417125444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1492 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464052",
            "telephone_number": "928-348-2151",
            "fax_number": "928-428-3617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1492 S 20TH AVE",
            "city": "SAFFORD",
            "state": "AZ",
            "postal_code": "855464052",
            "telephone_number": "928-348-2151",
            "fax_number": "928-428-3617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-12",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "928-348-2151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Safford, AZ

Sources for this page

Verify at the official NPI Registry.