NPIMap

Organization Active NPI

Mountain Park Health Center

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1487037958
Registry record updated Mar 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC 0599 Issued in AZ
Legal business name
MOUNTAIN PARK HEALTH CENTER
Practice address
5517 N 17TH Ave
Phoenix, AZ 85015-2516
Phone
(602) 243-7277
Fax
(602) 323-3399
NPI assigned
Jul 2, 2015
Last updated
Mar 13, 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 13, 2018

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

Authorized official

Name
Dr. John R SwagertNPI 1720047657
Title
Ceo
Phone
(602) 323-3242

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 0599 AZ Primary

Addresses

Primary practice location

5517 N 17TH Ave
Phoenix, AZ 85015-2516

Mailing address

3003 N Central Ave Ste 1600
Phoenix, AZ 85012-2908
Phone (602) 323-3345

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150922000527 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 1487037958. Details of each certification follow.

Federally qualified health center certification: CCN 031930

Legal name
MOUNTAIN PARK HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 11, 2015
Last certification
Sep 11, 2015
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1980 in AZ
Enrollment address
5517 N 17TH Ave
Phoenix, AZ 85015-2516

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
Part of
Mountain Park Health Center

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 OfficerCheif Executive Officer Oct 15, 2010
W-2 Managing EmployeeCheif 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 1

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": "1435795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520899200000",
    "number": "1487037958",
    "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": "602-323-3345",
            "fax_number": "602-323-3399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5517 N 17TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850152516",
            "telephone_number": "602-243-7277",
            "fax_number": "602-323-3399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN PARK HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAIN PARK HEALTH CENTER",
        "enumeration_date": "2015-07-02",
        "last_updated": "2018-03-13",
        "status": "A",
        "authorized_official_last_name": "SWAGERT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-323-3242",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC 0599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.