NPIMap

Organization Active NPI

Cobre Valley Regional Medical Center

  • Rural Health Clinic/Center
  • Young, AZ
National Provider Identifier
1497021844
Registry record updated Jan 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H0126 Issued in AZ
Legal business name
COBRE VALLEY REGIONAL MEDICAL CENTER
Practice address
124 N Tewskbury Blvd
Young, AZ 85554-0000
Phone
(928) 462-3435
Fax
(928) 462-6644
NPI assigned
Mar 30, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2013

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

Authorized official

Name
Neal D Jensen
Title
Ceo
Phone
(928) 425-3261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H0126 AZ Primary

Addresses

Primary practice location

124 N Tewskbury Blvd
Young, AZ 85554-0000

Mailing address

PO Box 177
Young, AZ 85554-0000
Phone (928) 462-3435

Other identifiers 1

IdentifierTypeStateIssuer
371306MedicaidAZ

Other names 1

  • Pleasant Valley Community Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030925000001 AZ Part A Provider - Rural Health Clinic 0648181693 1 other NPI on this enrollment
Practice locations: Young, AZ
O20040312001228 AZ Part B Supplier - Clinic/Group Practice 0648181693 Receives reassigned benefits from 69 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Young, AZ; Tonto Basin, AZ; Kearny, AZ; Globe, AZ; Superior, AZ

Rural health clinic certification: CCN 038500

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
PLEASANT VALLEY COMMUNITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2010
Last certification
Mar 5, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1988 in AZ
Enrollment address
124 N Tewksbury Blvd
Young, AZ 85554
Related CCNs
031314

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

Other NPIs with the same Medicare PAC ID 8

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.

National Provider Directory

National Provider Directory
Tax ID family
Cobre Valley Community Hospital13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

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
Cobre Valley Regional Medical Center Organization, Globe, AZ Non-profit 5% Or Greater Direct Ownership Interest Jul 10, 1998
Jack Bradford Individual Corporate DirectorVice Chairman Jun 23, 2022
Jody Daggett Individual Corporate DirectorChief of Medical Staff Jan 20, 2016
Edward Carpenter Individual Corporate Director Oct 24, 2006
Nick Renon Individual Corporate Director Jul 28, 2025
Paula Horn Individual Corporate DirectorSecretary Feb 22, 2024
Neal Duane Jensen Individual Contracted Managing EmployeeCeo Jul 10, 1998
Corporate OfficerCeo Jul 10, 1998
Alan Osumi Individual Corporate Director Mar 1, 2015
Robert E Hollis Individual Corporate Director Jul 22, 2014
Jendean G Sartain Individual Corporate Director Mar 1, 2008
Fernando Shipley Individual Corporate Director Aug 1, 2004
Judy Bessee Individual Corporate DirectorChairman Feb 28, 2017

Owners & managing parties with NPI records 10

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

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359504000000",
    "number": "1497021844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 177",
            "city": "YOUNG",
            "state": "AZ",
            "postal_code": "855540000",
            "telephone_number": "928-462-3435",
            "fax_number": "928-462-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 N TEWSKBURY BLVD",
            "city": "YOUNG",
            "state": "AZ",
            "postal_code": "855540000",
            "telephone_number": "928-462-3435",
            "fax_number": "928-462-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2013-01-30",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "NEAL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-425-3261"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "H0126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "371306",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pleasant Valley Community Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Young, AZ

Sources for this page

Verify at the official NPI Registry.