NPIMap

Organization Active NPI

Chiricahua Community Health Centers, Inc

Doing business as Benson Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Benson, AZ
National Provider Identifier
1821582529
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
OTC8971 Issued in AZ
Legal business name
CHIRICAHUA COMMUNITY HEALTH CENTERS, INC
Doing business as
Benson Family Health Center
Practice address
335 South Ocotillo Avenue
Benson, AZ 85602
Phone
(520) 364-1429
NPI assigned
Jun 18, 2018
Last updated
Sep 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Jonathan P Melk, M.D.NPI 1568496164
Title
Ceo
Phone
(520) 364-1429

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X OTC8971 AZ Primary

Addresses

Primary practice location

335 South Ocotillo Avenue
Benson, AZ 85602

Mailing address

1205 F Ave
Douglas, AZ 85607-1920
Phone (520) 364-6852

Other identifiers 1

IdentifierTypeStateIssuer
396154MedicaidAZ

Other names 1

  • Benson Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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
O20180827003562 AZ Part A Provider - Federally Qualified Health Center (FQHC) 5395638878 Practice locations: Benson, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821582529. Details of each certification follow.

Federally qualified health center certification: CCN 031976

Legal name
CHIRICAHUA COMMUNITY HEALTH CENTERS INC
Doing business as
BENSON FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 2, 2018
Last certification
Oct 2, 2018
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Dec 6, 1995 in AZ
Enrollment address
335 S Ocotillo Ave
Benson, AZ 85602-6406

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 14

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

View all 14

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
03D2148552Benson Family Health Center335 S Ocotillo Ave, Benson, AZ 85602Certificate of waiverMay 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Chiricahua Community Health Centers Inc22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

155 Calle Portal
Ste 300
Sierra Vista, AZ 85635
Phone (520) 458-6331

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
Alvaro Montoya Individual Corporate DirectorBoard Member Jun 25, 2019
Britt Hanson Individual Corporate DirectorBoard President Aug 20, 2022
Jonathan P Melk Individual Corporate OfficerCeo Jul 2, 2018
W-2 Managing EmployeeCeo Jul 2, 2018
Operational/Managerial ControlCeo Jul 2, 2018 100%
Joan Hansen Individual Corporate DirectorBoard Treasurer Jul 2, 2018
Gary M McPherran Individual Corporate OfficerDirector of Finance Jul 2, 2018
W-2 Managing EmployeeDirector of Finance Jul 2, 2018
Najayyah Many Horses Individual Corporate DirectorBoard Member May 16, 2022
George Cullinan Individual Corporate DirectorBoard Member Jul 2, 2018
Amy Haritatos Individual Corporate DirectorBoard Member Oct 17, 2022
Tamra Venice Springer Individual Corporate OfficerRevenue Cycle Manager Aug 3, 2023
W-2 Managing EmployeeRevenue Cycle Manager Aug 3, 2023
Manuel Bejarano Individual Corporate DirectorBoard Member Aug 19, 2024
Carrie Gustavson Individual Corporate DirectorBoard Vice President Jul 2, 2018
Alma Vildosola Individual Corporate DirectorBoard Member Nov 28, 2016
Chris Roll Individual Corporate DirectorBoard Member Sep 11, 2023

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1529280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1821582529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 F AVE",
            "city": "DOUGLAS",
            "state": "AZ",
            "postal_code": "856071920",
            "telephone_number": "520-364-6852",
            "fax_number": "520-364-4261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 SOUTH OCOTILLO AVENUE",
            "city": "BENSON",
            "state": "AZ",
            "postal_code": "85602",
            "telephone_number": "520-364-1429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIRICAHUA COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-18",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "MELK",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-364-1429",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AZ",
            "license": "OTC8971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "396154",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benson Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Benson Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benson, AZ

Sources for this page

Verify at the official NPI Registry.