NPIMap

Organization Active NPI

Black Canyon Community Health Center, Inc.

  • Family Medicine Physician
  • Black Canyon City, AZ
National Provider Identifier
1679723217
Registry record updated Jun 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
3297 Issued in AZ
Legal business name
BLACK CANYON COMMUNITY HEALTH CENTER, INC.
Practice address
19251 E Oasis Dr
Black Canyon City, AZ 85324-8878
Phone
(623) 374-0200
Fax
(623) 374-5576
NPI assigned
Sep 19, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2026

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

Authorized official

Name
Randy Charles HancockNPI 1467432971
Title
Ceo
Phone
(623) 374-0200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 3297 AZ Primary

Addresses

Primary practice location

19251 E Oasis Dr
Black Canyon City, AZ 85324-8878

Mailing address

PO Box 1958
Black Canyon City, AZ 85324-1958
Phone (623) 374-0200

Other identifiers 1

IdentifierTypeStateIssuer
397607MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090812000350 AZ Part B Supplier - Clinic/Group Practice 6406900331 Receives reassigned benefits from 8 practitioners
2 other NPIs on this enrollment
Practice locations: Black Canyon City, AZ; Mayer, AZ

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16465/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Black Canyon Community Health Center Inc.Black Canyon City, AZ, CCN 031013 Federally qualified health center Operational/Managerial Control (100%) Jul 1, 2008
Black Canyon Community Health CenterMayer, AZ, CCN 031018 Federally qualified health center Operational/Managerial Control (100%) Apr 11, 2023

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 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1221782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781740800000",
    "number": "1679723217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1958",
            "city": "BLACK CANYON CITY",
            "state": "AZ",
            "postal_code": "853241958",
            "telephone_number": "623-374-0200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19251 E OASIS DR",
            "city": "BLACK CANYON CITY",
            "state": "AZ",
            "postal_code": "853248878",
            "telephone_number": "623-374-0200",
            "fax_number": "623-374-5576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK CANYON COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-19",
        "last_updated": "2026-06-18",
        "certification_date": "2026-06-18",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "623-374-0200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "3297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "397607",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Black Canyon City, AZ

Sources for this page

Verify at the official NPI Registry.