NPIMap

Organization Active NPI

Palo Verde Health Care District

  • Rural Health Clinic/Center
  • Blythe, CA
National Provider Identifier
1740667179
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PALO VERDE HEALTH CARE DISTRICT
Practice address
291 N Second Street
Blythe, CA 92225-1777
Phone
(760) 922-4115
Fax
(760) 921-5263
NPI assigned
May 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Authorized official

Name
Mrs. Regina Veloz
Title
Executive Leadership Assistant
Phone
(760) 921-5150

Specialties & licenses 1

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

Addresses

Primary practice location

291 N Second Street
Blythe, CA 92225-1777

Mailing address

250 N 1St St
Blythe, CA 92225-1702
Phone (760) 922-4115

Other identifiers 1

IdentifierTypeStateIssuer
ZZT40423HMedicaidCA

Other names 1

  • Palo Verde Hospital Community Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051214000926 CA Part B Supplier - Clinic/Group Practice 3678593712 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Blythe, CA
O20150811004543 CA Part A Provider - Rural Health Clinic 3678593712 Practice locations: Blythe, CA

Rural health clinic certification: CCN 058716

Legal name
PALO VERDE HEALTH CARE DISTRICT
Doing business as
PALO VERDE HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 10, 2021
Last certification
Mar 10, 2021
Ownership / control type
2A
Organization structure
OtherNon-profit
Enrollment address
205 N First St
Blythe, CA 92225-1777
Related CCNs
050423

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2210367Palo Verde Community Clinic291 N Second St, Blythe, CA 92225Certificate of waiverMar 23, 2028

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
David Brooks Individual Corporate Officer Dec 9, 2014
Samuel a Burton Individual Corporate OfficerBoard Member Dec 9, 2014
Sandra J Anaya Individual Corporate OfficerCeo Jul 16, 2013
W-2 Managing EmployeeCeo Apr 2, 2015
Christa a Rohde Individual W-2 Managing EmployeeAssistant Cfo/Controller Apr 2, 2015
Sandra K Hudson Individual Corporate OfficerBoard Member Dec 7, 2012
Carmela F Garnica Individual Corporate OfficerBoard Member Dec 9, 2014
Trina R Sartin Individual Corporate Officer Dec 7, 2012

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Palo Verde HospitalBlythe, CA, CCN 051339 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 3, 2005

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1430870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739923200000",
    "number": "1740667179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N 1ST ST",
            "city": "BLYTHE",
            "state": "CA",
            "postal_code": "922251702",
            "telephone_number": "760-922-4115",
            "fax_number": "760-921-5263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 N SECOND STREET",
            "city": "BLYTHE",
            "state": "CA",
            "postal_code": "922251777",
            "telephone_number": "760-922-4115",
            "fax_number": "760-921-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALO VERDE HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-06",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "VELOZ",
        "authorized_official_first_name": "REGINA",
        "authorized_official_title_or_position": "EXECUTIVE LEADERSHIP ASSISTANT",
        "authorized_official_telephone_number": "760-921-5150",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT40423H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palo Verde Hospital Community Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Blythe, CA

Sources for this page

Verify at the official NPI Registry.