NPIMap

Organization Active NPI

Cobre Valley Regional Medical Center

  • Community/Retail Pharmacy
  • Globe, AZ
National Provider Identifier
1639384233
Registry record updated Jul 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2310 Issued in AZ
Legal business name
COBRE VALLEY REGIONAL MEDICAL CENTER
Practice address
5880 S Hospital Dr
Globe, AZ 85501-9447
Phone
(928) 425-3261
Fax
(928) 425-1193
NPI assigned
May 14, 2007
Last updated
Jul 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2017

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 2310 AZ Primary

Addresses

Primary practice location

5880 S Hospital Dr
Globe, AZ 85501-9447

Mailing address

5880 S Hospital Dr
Globe, AZ 85501-9447
Phone (928) 425-3261

Other identifiers 2

IdentifierTypeStateIssuer
0322583OtherAZNCPDP PROVIDER ID
1639384233OtherAZNPI

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20081006000059 AZ Part A Provider - Critical Access Hospital 0648181693 Receives reassigned benefits from 51 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Globe, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639384233. Details of each certification follow.

Hospital certification: CCN 031314

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 5, 2006
Last certification
Mar 6, 2025
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1988 in AZ
Enrollment address
5880 S Hospital Dr
Globe, AZ 85501-9447

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

Other NPIs on the same Medicare enrollment 10

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Cobre Valley Regional Medical CenterCCN 031314 · All quality measures
Overall star rating
2 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Cobre Valley Comm Hospi14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

14 N Magma Ave
Superior, AZ 85173
Phone (520) 689-2423

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
Jack Bradford Individual Corporate DirectorVice Chairman Jun 23, 2022
Jody Daggett Individual Corporate DirectorChief of Medical Staff (Ex Officio) Jan 20, 2016
Edward Carpenter Individual Corporate DirectorTrustee Oct 24, 2008
Nick Renon Individual Corporate DirectorTrustee Jul 28, 2025
Paula Horn Individual Corporate DirectorSecretary Feb 22, 2024
Neal Duane Jensen Individual Corporate OfficerCeo Jul 10, 1998
Alan Osumi Individual Corporate DirectorTrustee Mar 1, 2015
Robert E Hollis Individual Corporate DirectorTreasurer Jul 20, 2014
Jendean G Sartain Individual Corporate DirectorTrustee Mar 1, 2005
Frank Stapleton Individual W-2 Managing Employee Jan 25, 2002
Fernando Shipley Individual Corporate DirectorTrustee Aug 1, 2004
Judy Bessee Individual Corporate DirectorChairman Feb 10, 2017

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 58

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 58

Affiliated clinicians 154

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

View all 154

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499212800000",
    "number": "1639384233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5880 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019447",
            "telephone_number": "928-425-3261",
            "fax_number": "928-425-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5880 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019447",
            "telephone_number": "928-425-3261",
            "fax_number": "928-425-1193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2017-07-05",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AZ",
            "license": "2310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER ID",
            "identifier": "0322583",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639384233",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Globe, AZ

Sources for this page

Verify at the official NPI Registry.