NPIMap

Organization Active NPI

Cobre Valley Regional Medical Center

Doing business as Pleasant Valley Community Medical Center

  • Rural Health Clinic/Center
  • Young, AZ
National Provider Identifier
1811962848
Registry record updated Aug 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
OTC 0508 Issued in AZ
Legal business name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
Pleasant Valley Community Medical Center
Practice address
124 N Tewksbury Blvd
Young, AZ 85554
Phone
(928) 462-3435
Fax
(928) 462-6644
NPI assigned
Feb 22, 2006
Last updated
Aug 10, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2018

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

Authorized official

Name
Neal D. Jensen
Title
Cfo
Phone
(928) 425-3261

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X OTC 0508 AZ Primary

Addresses

Primary practice location

124 N Tewksbury Blvd
Young, AZ 85554

Mailing address

PO Box 177
Young, AZ 85554-0177
Phone (928) 462-3435

Other names 1

  • Pleasant Valley Community Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030925000001 AZ Part A Provider - Rural Health Clinic 0648181693 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Young, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811962848. Details of each certification follow.

Rural health clinic certification: CCN 038500

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
PLEASANT VALLEY COMMUNITY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2010
Last certification
Mar 5, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1988 in AZ
Enrollment address
124 N Tewksbury Blvd
Young, AZ 85554
Related CCNs
031314

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Cobre Valley Regional Medical Center Organization, Globe, AZ Non-profit 5% Or Greater Direct Ownership Interest Jul 10, 1998
Jack Bradford Individual Corporate DirectorVice Chairman Jun 23, 2022
Jody Daggett Individual Corporate DirectorChief of Medical Staff Jan 20, 2016
Edward Carpenter Individual Corporate Director Oct 24, 2006
Nick Renon Individual Corporate Director Jul 28, 2025
Paula Horn Individual Corporate DirectorSecretary Feb 22, 2024
Neal Duane Jensen Individual Contracted Managing EmployeeCeo Jul 10, 1998
Corporate OfficerCeo Jul 10, 1998
Alan Osumi Individual Corporate Director Mar 1, 2015
Robert E Hollis Individual Corporate Director Jul 22, 2014
Jendean G Sartain Individual Corporate Director Mar 1, 2008
Fernando Shipley Individual Corporate Director Aug 1, 2004
Judy Bessee Individual Corporate DirectorChairman Feb 28, 2017

Owners & managing parties with NPI records 11

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533859200000",
    "number": "1811962848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 177",
            "city": "YOUNG",
            "state": "AZ",
            "postal_code": "855540177",
            "telephone_number": "928-462-3435",
            "fax_number": "928-462-6644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 N TEWKSBURY BLVD",
            "city": "YOUNG",
            "state": "AZ",
            "postal_code": "85554",
            "telephone_number": "928-462-3435",
            "fax_number": "928-462-6644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2018-08-10",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "NEAL",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "928-425-3261"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "OTC 0508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pleasant Valley Community Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pleasant Valley Community Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Young, AZ

Sources for this page

Verify at the official NPI Registry.