Chiricahua Community Health Centers, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Douglas, AZ
NPI 1801821970 · NPPES record last updated Sep 1, 2021
Key facts
- NPI
- 1801821970
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- OTC3057 (AZ)
- Legal business name
- CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
- Practice address
- 1100 F Ave
Douglas, AZ 85607-1919 - Phone
- (520) 364-3285
- Fax
- (520) 364-3378
- NPI assigned
- Jul 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Jonathan P Melk, M.D.
- Title
- Ceo
- Phone
- (520) 364-1429
Owners & managing parties with NPI records 1
-
Jonathan Paul Melk, M.D.
Other NPIs on the same Medicare enrollment 14
Other NPIs with the same Medicare PAC ID 15
Corporate family (same tax ID) 21
Practitioners 47
-
Olivia Nicole Johnson, BSN, RN
-
Heather L Kinder, RN IBCLC
-
Dawn Azbill, FNP-C
-
Samantha Kalyani Bassett, FNP-C
-
Jessica Lynn Crewse, FNP
-
Gustavo Durazo Jr., DNP
-
Elizabeth Fabry, ANP
-
Jamie Lynn Fitzpatrick, APRN-RNP
-
Elizabeth Grijalva, APRN-CNP
-
Kerstin P Hurley, PHD
-
Clinton Lavar Huston, D.C.
-
Joshua Jean, MD
-
Tonya Lee Johnson, FNP-C
-
Polly Paccassi Lund, MSW, CSW-I
-
Dia Cherie Madden, FNP
-
Darlene R. Melk, MD
-
Deanna Lee Merrill, RN, CNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
Federally qualified health center certification: CCN 031946
- Legal name
- CHIRICAHUA COMMUNITY HEALTH CENTERS INC
- Doing business as
- CHIRICAHUA COMMUNITY HEALTH CENTERS - JENNIFER GINGER RYAN CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 20, 2016
- Last certification
- Dec 20, 2016
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 6, 1996
- Enrollment address
- 1100 F Ave
Douglas, AZ 85607-1919
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Demetry Simonton |
Corporate Director |
Jan 11, 2025 | |
| Alvaro Montoya |
Corporate Director |
Mar 27, 2017 | |
| Britt Hanson |
Corporate Director |
Aug 20, 2022 | |
| Jonathan P Melk |
Corporate Officer |
Dec 1, 2016 | |
| W-2 Managing Employee |
Dec 1, 2016 | ||
| Gary M McPherran |
Corporate Officer |
Dec 1, 2016 | |
| George Cullinan |
Corporate Director |
Mar 28, 2016 | |
| Amy Haritatos |
Corporate Director |
Oct 17, 2022 | |
| Tamra Venice Springer |
Corporate Officer | Jan 9, 2023 | |
| Corporate Director | Jan 9, 2023 | ||
| W-2 Managing Employee | Jan 9, 2023 | ||
| Carrie Gustavson |
Corporate Director |
Dec 1, 2016 | |
| Karl Griffor |
Corporate Director |
Dec 3, 2024 | |
| Alma Vildosola |
Corporate Director |
Nov 28, 2016 | |
| Caleb Blaschke |
Corporate Director |
Jan 11, 2025 | |
| Lawerence Sanders |
Corporate Director |
Jan 11, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040206000860 | AZ | Part B Supplier - Clinic/Group Practice | 5395638878 |
Receives reassigned benefits from 59 practitioners 14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bisbee, AZ; Willcox, AZ; Sierra Vista, AZ; Douglas, AZ; Elfrida, AZ; Benson, AZ |
| O20170117001934 | AZ | Part a Provider - Federally Qualified Health Center (FQHC) | 5395638878 | Practice locations: Douglas, AZ |
National Provider Directory
- Tax ID family
- Chiricahua Community Health
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | OTC3057 | AZ | Yes |
Addresses
Primary practice location
1100 F Ave
Douglas, AZ 85607-1919
Mailing address
1205 F Ave
Douglas, AZ 85607-1920
Phone (520) 364-6852
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 945132 | Medicaid | AZ |
Other providers in Douglas, AZ
- Mario Alejandro Chavez
- Child & Family Resources, Inc.
- Chiricahua Community Health Centers Inc
- Chiricahua Community Health Centers, Inc
- Chiricahua Community Health Centers, Inc
- Chiricahua Community Health Centers, Inc
- Chiricahua Community Health Centers, Inc
- Chiricahua Community Health Centers, Inc.
- Russell L Christopher Jr.
- City of Douglas
All providers in Douglas, AZ · Federally Qualified Health Center (FQHC) in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.