NPIMap

Organization Active NPI

Utah Navajo Health System, Incorporated

Doing business as Monument Valley Health Community Health Center

  • Family Medicine Physician
  • Monument Valley, UT
National Provider Identifier
1699803635
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UTAH NAVAJO HEALTH SYSTEM, INCORPORATED
Doing business as
Monument Valley Health Community Health Center
Practice address
30 West Medical Drive
Monument Valley, UT 84536-0005
Phone
(435) 727-3000
NPI assigned
Mar 1, 2007
Last updated
Jun 11, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Authorized official

Name
Mr. Michael Jensen
Title
Chief Executive Officer
Phone
(435) 651-3713

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

30 West Medical Drive
Monument Valley, UT 84536-0005

Mailing address

PO Box 130
Montezuma Creek, UT 84534-0130
Phone (435) 651-3766

Other identifiers 1

IdentifierTypeStateIssuer
1811991151OtherUTNPI MAIN LOCATION

Other names 1

  • Monument Valley Health Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120203000735 UT Part A Provider - Federally Qualified Health Center (FQHC) 1658275649 Practice locations: Monument Valley, UT

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1699803635. Details of each certification follow.

Federally qualified health center certification: CCN 461835

Legal name
UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Doing business as
MONUMENT VALLEY HEALTH CENTER-SATELLITE
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2000 in UT
Enrollment address
30 West Medical Drive
Monument Valley Health Center-Satellite
Monument Valley, UT 84536

Rural health clinic certification: CCN 463818

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MONUMENT VALLEY HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 26, 2001
Last certification
May 24, 2017
Ownership / control type
2B
Facility address
30 W Medical Drive
Monument Valley, UT 84536

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Lloyd V Jones Individual Corporate OfficerChief Medical Officer Aug 1, 2011 15%
Michael S Jensen Individual Corporate OfficerChief Executive Officer Aug 23, 2011 100%
Utah Navajo Health System Incorporated Organization, Montezuma Creek,, UT For-profit Operational/Managerial Control Aug 23, 2018 100%
Tiffany Mitchell Individual W-2 Managing EmployeeAccounts Receivable Manager May 1, 2019 10%
Jamie Harvey Individual Corporate DirectorBoard Member Aug 1, 2011
Gloria Begaye Individual Corporate DirectorBoard Member Aug 1, 2011
Harriett Lansing Individual Corporate DirectorBoard Member Aug 1, 2011
Cassandra Beletso Individual Corporate DirectorBoard Member Aug 1, 2011
Wilfred R Jones Individual Corporate DirectorBoard Member Aug 23, 2011
Alva B Clarke Individual Corporate OfficerChief Operation Officer May 1, 2016 100%
Melinda Farley Individual Corporate DirectorBoard Member Aug 1, 2011
Edward Tapaha Individual Corporate DirectorBoard Member Aug 1, 2011
Kenneth Miles Individual Corporate DirectorBoard Member Aug 1, 2011
Andrew Evans Individual Corporate OfficerChief Financial Officer Feb 14, 2019 50%

Owners & managing parties with NPI records 4

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
Blanding Family Practice Community Health CenterBlanding, UT, CCN 461833 Federally qualified health center Operational/Managerial Control (100%) Aug 23, 2011

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1699803635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "MONTEZUMA CREEK",
            "state": "UT",
            "postal_code": "845340130",
            "telephone_number": "435-651-3766",
            "fax_number": "435-651-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 WEST MEDICAL DRIVE",
            "city": "MONUMENT VALLEY",
            "state": "UT",
            "postal_code": "845360005",
            "telephone_number": "435-727-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH NAVAJO HEALTH SYSTEM, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "435-651-3713",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI MAIN LOCATION",
            "identifier": "1811991151",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monument Valley Health Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monument Valley Health Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monument Valley, UT

Sources for this page

Verify at the official NPI Registry.