NPIMap

Organization Active NPI

Chiricahua Community Health Centers, Inc

Doing business as CCHCI SEABHS Clinic

  • Federally Qualified Health Center (FQHC)
  • Sierra Vista, AZ
National Provider Identifier
1487175162
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC8372 Issued in AZ
Legal business name
CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Doing business as
CCHCI SEABHS Clinic
Practice address
4755 Campus Dr
Sierra Vista, AZ 85635-2449
Phone
(520) 459-3011
Fax
(520) 364-4261
NPI assigned
Jul 3, 2017
Last updated
Sep 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Jonathan P Melk
Title
Ceo
Phone
(520) 364-6852

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC8372 AZ Primary

Addresses

Primary practice location

4755 Campus Dr
Sierra Vista, AZ 85635-2449

Mailing address

1205 F Ave
Douglas, AZ 85607-1920
Phone (520) 364-6852

Other identifiers 1

IdentifierTypeStateIssuer
275274MedicaidAZ

Other names 1

  • CCHCI SEABHS Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040206000860 AZ Part B Supplier - Clinic/Group Practice 5395638878 Receives reassigned benefits from 59 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bisbee, AZ; Willcox, AZ; Sierra Vista, AZ; Douglas, AZ; Elfrida, AZ; Benson, AZ

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory

Locations

10566 N Highway 191
Elfrida, AZ 85610
Phone (520) 642-2222

Practitioners & affiliated clinicians

Practitioners 4

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": "1499040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1487175162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 F AVE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071920",
            "telephone_number": "520-364-6852",
            "fax_number": "520-364-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 CAMPUS DR",
            "city": "SIERRA VISTA",
            "state": "AZ",
            "postal_code": "856352449",
            "telephone_number": "520-459-3011",
            "fax_number": "520-364-4261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRICAHUA COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-03",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "MELK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-364-6852"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC8372",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275274",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CCHCI SEABHS Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sierra Vista, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.