NPIMap

Organization Active NPI

Maricopa County Special Health Care District

Doing business as Valleywise Mobile Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1629840137
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Doing business as
Valleywise Mobile Health Clinic
Practice address
2601 E Roosevelt St
Phoenix, AZ 85008-4973
Phone
(602) 344-5011
NPI assigned
Oct 27, 2023
Last updated
Apr 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Authorized official

Name
Pamela S Fowler, MS
Title
System Director of Reimbursement
Phone
(602) 344-2830

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
General Acute Care Hospital 282N00000X

Addresses

Primary practice location

2601 E Roosevelt St
Phoenix, AZ 85008-4973

Mailing address

PO Box 29670
Phoenix, AZ 85038-9670
Phone (602) 344-8100

Other names 1

  • Valleywise Mobile Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071002000192 AZ Part A Provider - Hospital 4688583651 14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ; Peoria, AZ; Mesa, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629840137. Details of each certification follow.

Hospital certification: CCN 030022

Legal name
MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Doing business as
VALLEYWISE HEALTH
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 20, 2018
Beds
758
Ownership / control type
Local
Organization structure
GovernmentNon-profit
Enrollment address
2601 E Roosevelt St
Phoenix, AZ 85008-4973
Other Hospital Practice Location
Hospital subgroups
General, Acute care

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Valleywise Health Medical CenterCCN 030022 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Martin Demos Individual Corporate DirectorDirector Dec 2, 2024
Virginia Korte Individual Corporate DirectorDirector Dec 2, 2024
Barbara Mundell Individual Corporate DirectorDirector Feb 11, 2025
Maricopa County Special Health Care District Organization, Phoenix, AZ Medical provider/supplier, Non-profit Operational/Managerial Control Jan 1, 2005 100%
Earl Wilcox Individual Corporate DirectorDirector Dec 2, 2024
Claire Frieda Agnew Individual Corporate OfficerInterim Cfo Aug 1, 2020
James W. Thomas Individual Corporate Director Dec 4, 2018
Pamela Fowler Individual W-2 Managing Employee Jul 23, 2018
Operational/Managerial ControlDirector Jul 23, 2018
Stephen Purves Individual Corporate Officer Sep 30, 2013
W-2 Managing EmployeePresident and Chief Executive Offic Sep 30, 2013

Owners & managing parties with NPI records 14

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

View all 14

Practitioners & affiliated clinicians

Affiliated clinicians 409

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 409

NPI Registry JSON

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

{
    "created_epoch": "1698364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714003200000",
    "number": "1629840137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29670",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850389670",
            "telephone_number": "602-344-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 E ROOSEVELT ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850084973",
            "telephone_number": "602-344-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-27",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR OF REIMBURSEMENT",
        "authorized_official_telephone_number": "602-344-2830",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valleywise Mobile Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.