NPIMap

Organization Active NPI

Cobre Valley Regional Medical Center

Doing business as Superior Clinic

  • Rural Health Clinic/Center
  • Superior, AZ
National Provider Identifier
1649245135
Registry record updated Aug 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H0126 Issued in AZ
Legal business name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
Superior Clinic
Practice address
1134 W US Highway 60
Superior, AZ 85173
Phone
(520) 689-2423
Fax
(520) 689-5237
NPI assigned
Feb 20, 2006
Last updated
Aug 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2018

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H0126 AZ Primary

Addresses

Primary practice location

1134 W US Highway 60
Superior, AZ 85173

Mailing address

1134 W US Highway 60
Superior, AZ 85173-3400
Phone (520) 689-2423

Other identifiers 2

IdentifierTypeStateIssuer
1649245135OtherAZNPI
934467MedicaidAZ

Other names 1

  • Superior Clinic Doing business as

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
O20040902001147 AZ Part A Provider - Rural Health Clinic 0648181693 Practice locations: Superior, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649245135. Details of each certification follow.

Rural health clinic certification: CCN 033993

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
SUPERIOR CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 26, 2005
Last certification
Mar 3, 2025
Ownership / control type
2A
Organization structure
CorporationNon-profit
Incorporated
Jan 17, 2000 in AZ
Enrollment address
1134 W US Highway 60
Superior, AZ 85173-3400
Related CCNs
031314

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Cobre Valley Community Hospital13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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
Jack Bradford Individual Corporate DirectorVice Chairman Jun 23, 2022
Jody Daggett Individual Corporate DirectorChief of Medical Staff Jan 20, 2016
Edward Carpenter Individual Corporate DirectorTrustee Oct 24, 2006
Nick Renon Individual Corporate Director Jul 28, 2025
Paula Horn Individual Corporate DirectorSecretary Feb 22, 2024
Neal Duane Jensen Individual Corporate OfficerCeo Jul 10, 1998
Alan Osumi Individual Corporate Director Feb 24, 2015
Robert E Hollis Individual Corporate DirectorTreasurer Jul 22, 2014
Jendean G Sartain Individual Corporate DirectorTrustee Mar 23, 2005
Frank Stapleton Individual W-2 Managing EmployeeCcoo Jan 27, 2002
Fernando Shipley Individual Corporate Director Aug 24, 2004
Judy Bessee Individual Corporate DirectorChairman Feb 28, 2017

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Pleasant Valley Community Medical CenterYoung, AZ, CCN 038500 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 10, 1998

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1140393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1649245135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1134 W US HIGHWAY 60",
            "city": "SUPERIOR",
            "state": "AZ",
            "postal_code": "851733400",
            "telephone_number": "520-689-2423",
            "fax_number": "520-689-5237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1134 W US HIGHWAY 60",
            "city": "SUPERIOR",
            "state": "AZ",
            "postal_code": "85173",
            "telephone_number": "520-689-2423",
            "fax_number": "520-689-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-20",
        "last_updated": "2018-08-09",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "H0126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1649245135",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "934467",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Superior Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Superior Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Superior, AZ

Sources for this page

Verify at the official NPI Registry.