NPIMap

Organization Active NPI

Cobre Valley Regional Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Globe, AZ
National Provider Identifier
1730333758
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
H0126 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) 425-8218
NPI assigned
Nov 5, 2008
Last updated
Sep 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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
Medicare Defined Swing Bed Hospital Unit 275N00000X H0126 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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120309000062 AZ Part A Provider - Critical Access Hospital 0648181693 Practice locations: Globe, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730333758. Details of each certification follow.

Hospital certification: CCN 03Z314

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1988 in AZ
Enrollment address
5880 S Hospital Dr
Globe, AZ 85501-9447
Other Hospital Practice Location

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).

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 13

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
Healthtech Management Services Inc Organization, Franklin, TN Corporation Operational/Managerial Control Aug 18, 1992
Jody Daggett Individual Corporate DirectorChief of Medical Staff (Ex Officio) Jan 20, 2016
Edward Carpenter Individual Corporate DirectorTrustee Oct 24, 2006
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 OfficerTrustee 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 EmployeeChief Clinical Operations Officer Jan 25, 2002
Fernando Shipley Individual Corporate DirectorTrustee Aug 1, 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.

Facilities with the same owner 7

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

NPI Registry JSON

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1730333758",
    "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": "928-425-8218"
        },
        {
            "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": "928-425-8218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2012-09-28",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AZ",
            "license": "H0126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Globe, AZ

Sources for this page

Verify at the official NPI Registry.