Parker Medical Center, LTD.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PARKER MEDICAL CENTER, LTD.

Practice address

905 Fiesta
Parker, AZ 85344-5152

Phone

(928) 669-2225

Fax

(928) 669-6751

NPI assigned

Jun 30, 2005

Last updated

Jul 25, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alicia Ann Shillito

Title

Office Manager

Phone

(928) 669-2225

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568469906. Details of each certification follow.

• CCN 033836 Rural health clinic · Active · Details

Rural health clinic certification: CCN 033836

Legal name

PARKER MEDICAL CENTER, LTD.

Doing business as

PARKER MEDICAL CENTER

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 14, 2015

Last certification

Sep 23, 2021

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Aug 14, 1973 in AZ

Enrollment address

905 S Fiesta Ave
Parker, AZ 85344-5152

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• Keith Westley Shillito, M.D.

  • Adult Medicine Physician
  • Tucson, AZ
  • NPI 1417954850

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership

Practitioners 2

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.

• Sandra G Matheny, AGNP-C

  • Adult Health Nurse Practitioner
  • Sierra Vista, AZ
  • NPI 1134854615
  Medicare reassignment Care Compare group NPD
• Keith Westley Shillito, M.D.

  • Adult Medicine Physician
  • Tucson, AZ
  • NPI 1417954850
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469404800000",
    "number": "1568469906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 FIESTA",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853445152",
            "telephone_number": "928-669-2225",
            "fax_number": "928-669-6751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 FIESTA",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853445152",
            "telephone_number": "928-669-2225",
            "fax_number": "928-669-6751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKER MEDICAL CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2016-07-25",
        "status": "A",
        "authorized_official_last_name": "SHILLITO",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "928-669-2225"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": null,
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "AZ",
            "license": "32755",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "862690",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Parker Family Practice PLLC
• Parker Indain Healthcare Center
• Parker Indian Health Center
• Parker Indian Health Service
• Parker Medical Center, LTD
• Parker Optical
• Parker Professional Services Group LLC
• Parker Unified School District
• Ronald Dale Parker, MD
• Sandhya Patel

• Rural Health Clinic/Center in Parker, AZ
• Providers in Parker, AZ by specialty
• Rural Health Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.