NPIMap

Organization Active NPI

Bisbee Hospital Association

Doing business as Copper Queen Medical Associates

  • Point of Service
  • Bisbee, AZ
National Provider Identifier
1508137209
Registry record updated Sep 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
H0098 Issued in AZ
Legal business name
BISBEE HOSPITAL ASSOCIATION
Doing business as
Copper Queen Medical Associates
Practice address
7 Bisbee Rd
Bisbee, AZ 85603-1140
Phone
(520) 432-2042
NPI assigned
Jan 26, 2012
Last updated
Sep 23, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
BISBEE HOSPITAL ASSOCIATION COPPER QUEEN COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2019

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

Authorized official

Name
Mr. Robert Seamon
Title
Ceo
Phone
(520) 432-6400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X H0098 AZ Primary

Addresses

Primary practice location

7 Bisbee Rd
Bisbee, AZ 85603-1140

Mailing address

101 Cole Ave
Bisbee, AZ 85603-1327
Phone (520) 432-2042

Other names 1

  • Copper Queen Medical Associates Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040623001007 AZ Part B Supplier - Clinic/Group Practice 5092626168 Receives reassigned benefits from 134 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bisbee, AZ; Hereford, AZ; Douglas, AZ
O20150324002513 AZ Part A Provider - Rural Health Clinic 5092626168 Practice locations: Bisbee, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508137209. Details of each certification follow.

Rural health clinic certification: CCN 033830

Legal name
BISBEE HOSPITAL ASSOCIATION
Doing business as
COPPER QUEEN MEDICAL ASSOCIATES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 12, 2004
Last certification
May 16, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 22, 1977 in AZ
Enrollment address
7 Bisbee Rd
Bisbee, AZ 85603-1140

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Copper Queen Pharmacy

Locations

7 Bisbee Rd
Bisbee, AZ 85603
Phone (520) 432-2042

100 W 5th St
Douglas, AZ 85607
Phone (520) 364-7659

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John Goldthorpe Individual Corporate Director Jan 1, 2010
John Harris Individual Corporate Director Jan 1, 2010
Heather Lundstrom Individual Corporate OfficerCfo Jul 1, 2018 100%
Kathleen Heard Individual Corporate Director Jan 1, 2010
Peter Carberry Individual Corporate Director Jan 1, 2010
Dennis Nelson Individual Corporate Director Jan 1, 2010
Laura Chavez Individual Corporate Director Jan 1, 2010
Robert Seamon Individual Corporate OfficerCeo Aug 13, 2018 100%
W-2 Managing EmployeeCeo Aug 13, 2018 100%
Brena Mercer Individual Corporate Director Jan 1, 2010
Gary Dillard Individual Corporate Director Jan 1, 2010
Robert F Howell Individual Corporate Director Jan 1, 2010

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Copper Queen Medical AssociatesDouglas, AZ, CCN 033829 Rural health clinic Operational/Managerial Control (100%) Mar 31, 2009

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 49

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 49

NPI Registry JSON

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

{
    "created_epoch": "1327536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569196800000",
    "number": "1508137209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 COLE AVE",
            "city": "BISBEE",
            "state": "AZ",
            "postal_code": "856031327",
            "telephone_number": "520-432-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 BISBEE RD",
            "city": "BISBEE",
            "state": "AZ",
            "postal_code": "856031140",
            "telephone_number": "520-432-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BISBEE HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BISBEE HOSPITAL ASSOCIATION COPPER QUEEN COMMUNITY HOSPITAL",
        "enumeration_date": "2012-01-26",
        "last_updated": "2019-09-23",
        "status": "A",
        "authorized_official_last_name": "SEAMON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-432-6400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "AZ",
            "license": "H0098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Copper Queen Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Copper Queen Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bisbee, AZ

Sources for this page

Verify at the official NPI Registry.