NPIMap

Organization Active NPI

Mariposa Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Nogales, AZ
National Provider Identifier
1417985474
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARIPOSA COMMUNITY HEALTH CENTER, INC
Practice address
1852 N Mastick Way
Nogales, AZ 85621-1063
Phone
(520) 281-1550
Fax
(520) 281-4487
NPI assigned
Jun 29, 2006
Last updated
Feb 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Authorized official

Name
Amy Taylor
Title
Chief Executive Officer
Phone
(520) 761-2128

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Public Health DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223D0001X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X
Licensed Practical NurseGroup: 193200000X MULTI-SPECIALTY GROUP 164W00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1852 N Mastick Way
Nogales, AZ 85621-1063

Mailing address

825 N Grand Ave Ste 100
Nogales, AZ 85621-2385
Phone (520) 761-2128

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20031226000065 AZ Part B Supplier - Clinic/Group Practice 8123926326 Receives reassigned benefits from 58 practitioners
7 other NPIs on this enrollment
Practice locations: Nogales, AZ; Tubac, AZ; Rio Rico, AZ; Patagonia, AZ
O20100211000670 AZ Part A Provider - Federally Qualified Health Center (FQHC) 8123926326 Practice locations: Nogales, AZ
O20100423000507 AZ Part A Provider - Federally Qualified Health Center (FQHC) 8123926326 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nogales, AZ
O20100426000401 AZ Part A Provider - Federally Qualified Health Center (FQHC) 8123926326 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rio Rico, AZ

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1417985474. Details of each certification follow.

Federally qualified health center certification: CCN 031812

Legal name
MARIPOSA COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 22, 1985 in AZ
Enrollment address
1852 N Mastick Way
Nogales, AZ 85621-1063

Federally qualified health center certification: CCN 031884

Legal name
MARIPOSA COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 7, 2010
Last certification
May 7, 2010
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jul 22, 1985 in AZ
Enrollment address
1835 N Mastick Way
Nogales, AZ 85621-1064

Federally qualified health center certification: CCN 031885

Legal name
MARIPOSA COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 7, 2010
Last certification
May 7, 2010
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jul 22, 1985 in AZ
Enrollment address
1103 Circulo Mercado
Rio Rico, AZ 85648-6248

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Carlos Bustamante Individual Corporate DirectorBoard Member Jun 27, 2019
Corporate DirectorBoard Member Oct 7, 1998
Aaryn Giblin Individual Corporate DirectorBoard Member Mar 16, 2023
Ernesto Chavez Individual Corporate DirectorBoard Member Oct 7, 1998
Corporate DirectorVice President Oct 7, 1998
Jennifer St. John Individual Corporate DirectorBoard Member Mar 16, 2023
Corporate DirectorBoard Member Jun 16, 2023
Judith Claremon Individual Corporate DirectorBoard Member Jul 7, 2005
Robert Lineiro Individual Corporate DirectorBoard Member Nov 25, 1985
Corporate DirectorBoard Member Jul 7, 2005
Chris Young Individual Corporate DirectorBoard Member Mar 17, 2022
Sandra Kory Individual Corporate DirectorBoard Member Mar 21, 2024
Lois Morris Individual Corporate DirectorBoard Member Mar 1, 2012
Lourdes Jeong Individual Corporate DirectorBoard Member Oct 11, 2001
Tia Duncan Individual Corporate DirectorChief of Administration Oct 23, 2016
W-2 Managing EmployeeChief of Administration Jun 28, 2010
Corporate OfficerChief of Administration Jun 28, 2010
W-2 Managing EmployeeAd;Chief of Administration Jun 28, 2010
Mariposa Community Health Center Inc Organization, Nogales, AZ Corporation, Non-profit Operational/Managerial Control Oct 1, 1991
Operational/Managerial Control Jan 1, 1980
Operational/Managerial Control Jan 1, 2006
Rudy Pina Individual Corporate DirectorBoard Member Feb 28, 1988
Amy Taylor Individual Corporate DirectorChief Executive Officer Nov 19, 2024
W-2 Managing EmployeeChief Executive Officer Nov 19, 2024
Corporate OfficerChief Executive Officer Nov 19, 2024
W-2 Managing EmployeeAd; Nov 27, 2023
Anthony Vartola Individual Corporate DirectorBoard Member Jun 27, 2019
Corporate DirectorBoard President Jun 27, 2019
John Wemlinger Individual Corporate DirectorBoard Member Sep 29, 2022

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Mariposa Community Health Center IncNogales, AZ, CCN 031884 Federally qualified health center Operational/Managerial Control Jan 1, 1980
Mariposa Community Health Center IncRio Rico, AZ, CCN 031885 Federally qualified health center Operational/Managerial Control Jan 1, 2006
Family Health CenterPatagonia, AZ, CCN 031809 Federally qualified health center Operational/Managerial Control Oct 1, 1991
Mariposa Community Health Center IncTubac, AZ, CCN 031938 Federally qualified health center Operational/Managerial Control Feb 15, 2016
Mariposa Community Health Center IncNogales, AZ, CCN 031003 Federally qualified health center Operational/Managerial Control Nov 30, 2020
Maternal Child Health Center of ExcellenceNogales, AZ, CCN 031079 Federally qualified health center Operational/Managerial Control Jan 1, 1980

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 80

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 80

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1417985474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N GRAND AVE STE 100",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856212385",
            "telephone_number": "520-761-2128",
            "fax_number": "520-281-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1852 N MASTICK WAY",
            "city": "NOGALES",
            "state": "AZ",
            "postal_code": "856211063",
            "telephone_number": "520-281-1550",
            "fax_number": "520-281-4487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIPOSA COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "520-761-2128"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223D0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nogales, AZ

Sources for this page

Verify at the official NPI Registry.