NPIMap

Organization Active NPI

La Paz Regional Hospital Inc

Doing business as La Paz Healthcare Kofa Clinic

  • Rural Health Clinic/Center
  • Parker, AZ
National Provider Identifier
1487022950
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
HO138 Issued in AZ
Legal business name
LA PAZ REGIONAL HOSPITAL INC
Doing business as
La Paz Healthcare Kofa Clinic
River Health Clinic
Practice address
1200 W Mohave Rd
Parker, AZ 85344-6349
Phone
(928) 669-7380
Fax
(928) 669-7371
NPI assigned
Sep 14, 2015
Last updated
Jan 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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

Authorized official

Name
Kevin Brown
Title
Ceo
Phone
(928) 669-7300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X HO138 AZ
Rural Health Clinic/Center 261QR1300X HO138 AZ Primary

Addresses

Primary practice location

1200 W Mohave Rd
Parker, AZ 85344-6349

Mailing address

1200 W Mohave Rd
Parker, AZ 85344-6349
Phone (928) 669-7400

Other names 2

  • LA PAZ HEALTHCARE KOFA CLINIC Doing business as
  • RIVER HEALTH CLINIC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031219000694 AZ Part B Supplier - Clinic/Group Practice 1557273356 Receives reassigned benefits from 94 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salome, AZ; Quartzsite, AZ; Parker, AZ; Bouse, AZ
O20160825002593 AZ Part A Provider - Rural Health Clinic 1557273356 Practice locations: Parker, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487022950. Details of each certification follow.

Rural health clinic certification: CCN 038505

Legal name
LA PAZ REGIONAL HOSPITAL INC
Doing business as
RIVER HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 23, 2016
Last certification
Nov 7, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 14, 2016 in AZ
Enrollment address
1200 W Mohave Rd
Parker, AZ 85344-6349
Related CCNs
031317

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2173650River Health Clinic1200 W Mohave Rd, Parker, AZ 85344Provider-performed microscopyOct 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Parker Community Hospit9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Keith W Shillito Individual Corporate Officer Apr 1, 2016
Jerry Palmer Individual Corporate Officer Sep 1, 2012
Lin Bachtel Individual Corporate Officer Jun 1, 2018
Mary Hamilton Individual Corporate Officer Oct 1, 2016
Norman Simpson Individual Corporate Officer Sep 1, 2012
Robert Page Individual Corporate Officer Feb 1, 2017
Julian Barbara Individual Corporate Officer Oct 1, 1990
Zafer Genc Individual W-2 Managing Employee Jan 1, 2022
Cheryl Montijo Individual Corporate Officer Oct 1, 2000

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
La Paz Regional Hospital IncParker, AZ, CCN 031317 Hospital Operational/Managerial Control (100%) Jan 1, 2017
La Paz Regional Hospital IncParker, AZ, CCN 03Z317 Hospital Operational/Managerial Control Jan 1, 2017
La Paz Medical Services-QuartzsiteQuartzsite, AZ, CCN 033987 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 7, 1994
Tri-Valley Medical CenterSalome, AZ, CCN 033994 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2006
Bouse Medical ClinicBouse, AZ, CCN 033999 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 1990

Owned or controlled facilities with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610496000000",
    "number": "1487022950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W MOHAVE RD",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853446349",
            "telephone_number": "928-669-7400",
            "fax_number": "928-669-7409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 W MOHAVE RD",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853446349",
            "telephone_number": "928-669-7380",
            "fax_number": "928-669-7371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PAZ REGIONAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-14",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-669-7300"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "AZ",
            "license": "HO138",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "HO138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LA PAZ HEALTHCARE KOFA CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RIVER HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Parker, AZ

Sources for this page

Verify at the official NPI Registry.