NPIMap

Organization Active NPI

La Paz Regional Hospital, Inc.

Doing business as Tri-Valley Medical Center

  • Rural Health Clinic/Center
  • Salome, AZ
National Provider Identifier
1629093539
Registry record updated Apr 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H0138 Issued in AZ
Legal business name
LA PAZ REGIONAL HOSPITAL, INC.
Doing business as
Tri-Valley Medical Center
Practice address
39726 Harquahala Road
Salome, AZ 85348
Phone
(928) 859-3460
Fax
(928) 859-3475
NPI assigned
Jul 12, 2006
Last updated
Apr 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2026

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

Authorized official

Name
Guadalupe Michelle Baldenegro
Title
Medical Staff Coordinator
Phone
(928) 669-7382

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H0138 AZ Primary

Addresses

Primary practice location

39726 Harquahala Road
Salome, AZ 85348

Mailing address

1200 W Mohave Rd
Parker, AZ 85344-6349
Phone (928) 669-9201

Other identifiers 2

IdentifierTypeStateIssuer
CG7880OtherAZMEDICARE RR
480046MedicaidAZ

Other names 1

  • Tri-Valley 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
O20031219000694 AZ Part B Supplier - Clinic/Group Practice 1557273356 Receives reassigned benefits from 94 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salome, AZ; Quartzsite, AZ; Parker, AZ; Bouse, AZ
O20050628001431 AZ Part A Provider - Rural Health Clinic 1557273356 Practice locations: Salome, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629093539. Details of each certification follow.

Rural health clinic certification: CCN 033994

Legal name
LA PAZ REGIONAL HOSPITAL INC
Doing business as
TRI-VALLEY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 30, 2005
Last certification
Aug 5, 2020
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 9, 1972 in AZ
Enrollment address
39726 Harquahala Rd
Salome, AZ 85348
Related CCNs
031317

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

Other NPIs with the same Medicare PAC ID 6

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D1039169La Paz Regional Hospital Dba Tri-Valley Medical39726 Harquahala Rd, Salome, AZ 85348Certificate of waiverJun 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
La Paz Regional Hospita9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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
Keith W Shillito Individual Corporate Director Apr 1, 2016
La Paz Regional Hospital Inc Organization, Parker, AZ Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2006 100%
Lin Bachtel Individual Corporate Director Sep 1, 2018
Mary Hamilton Individual Corporate Director Oct 1, 2016
Cory Madoneczky Individual Corporate Officer Feb 1, 2023
Norman Simpson Individual Corporate Director Sep 1, 2012
Robert Page Individual Corporate Director Feb 1, 2017
Julian Barbara Individual Corporate DirectorBoard Member Oct 1, 2011
Zafer Genc Individual Corporate Officer Jan 1, 2022
W-2 Managing Employee Jan 1, 2022
Randy Smith Individual Corporate Director Feb 1, 2023
Cheryl Montijo Individual Corporate DirectorBoard Member Oct 1, 2012
Linda M Cushman Individual Corporate Director Jun 1, 2018

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
La Paz Regional Hospital IncParker, AZ, CCN 031317 Hospital Operational/Managerial Control (100%) Jan 1, 2017
La Paz Regional Hospital IncParker, AZ, CCN 03Z317 Hospital Operational/Managerial Control Jan 1, 2017
La Paz Medical Services-QuartzsiteQuartzsite, AZ, CCN 033987 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 7, 1994
Bouse Medical ClinicBouse, AZ, CCN 033999 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 1, 1990

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 9

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": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777248000000",
    "number": "1629093539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 W MOHAVE RD",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853446349",
            "telephone_number": "928-669-9201",
            "fax_number": "928-669-7417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39726 HARQUAHALA ROAD",
            "city": "SALOME",
            "state": "AZ",
            "postal_code": "85348",
            "telephone_number": "928-859-3460",
            "fax_number": "928-859-3475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA PAZ REGIONAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2026-04-27",
        "certification_date": "2026-04-27",
        "status": "A",
        "authorized_official_last_name": "BALDENEGRO",
        "authorized_official_first_name": "GUADALUPE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "MEDICAL STAFF COORDINATOR",
        "authorized_official_telephone_number": "928-669-7382"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "H0138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "CG7880",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "480046",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tri-Valley Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salome, AZ

Sources for this page

Verify at the official NPI Registry.