NPIMap

Organization Active NPI

Nevada Health Centers, Inc.

Doing business as Amargosa Valley Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Amargosa Valley, NV
National Provider Identifier
1831278720
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
291803 Issued in NV
Legal business name
NEVADA HEALTH CENTERS, INC.
Doing business as
Amargosa Valley Medical Clinic
Practice address
1690 E Amargosa Farm Rd
Amargosa Valley, NV 89020-9735
Phone
(775) 372-5432
Fax
(775) 372-1303
NPI assigned
Nov 3, 2006
Last updated
Feb 5, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
NEVADA HEALTH CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
Walter B Davis
Title
Ceo
Phone
(775) 888-6610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 291803 NV Primary

Addresses

Primary practice location

1690 E Amargosa Farm Rd
Amargosa Valley, NV 89020-9735

Mailing address

3325 Research Way
Attn: Pat
Carson City, NV 89706-7913
Phone (775) 888-6610

Other identifiers 2

IdentifierTypeStateIssuer
1831278720MedicaidNV
DQ468DOtherNVMEDICARE ID-TYPE UNSPECIFIED

Other names 1

  • Amargosa Valley Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000452 NV Part B Supplier - Clinic/Group Practice 7113835307 Receives reassigned benefits from 65 practitioners
34 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Las Vegas, NV; North Las Vegas, NV; Pahrump, NV; Reno, NV; Virginia City, NV; West Wendover, NV; Amargosa Valley, NV; Austin, NV…
O20080529000446 NV Part A Provider - Federally Qualified Health Center (FQHC) 7113835307 Practice locations: Amargosa Valley, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831278720. Details of each certification follow.

Federally qualified health center certification: CCN 291803

Legal name
NEVADA HEALTH CENTERS INC
Doing business as
AMARGOSA VALLEY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 22, 1992 in NV
Enrollment address
1690 E Amargosa Farm Rd
Amargosa Valley, NV 89020-9735

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 34

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

View all 34

National Provider Directory

National Provider Directory
Part of
Fernley Family Medical

Locations

845 E Farm Rd
#69
Amargosa Valley, NV 89020
Phone (775) 372-5432

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Donald E Chaney Individual Corporate DirectorBoard Member Aug 1, 2012
Alicia Y Barnes Individual Corporate DirectorBoard Member Aug 1, 2012
Gerald Ackerman Individual Corporate DirectorBoard Member Mar 1, 2011
Linda Bingaman Individual Corporate DirectorBoard Member May 15, 2015
Kathryn L Triplett Individual Corporate OfficerChief Financial Officer Oct 1, 2016 100%
W-2 Managing EmployeeChief Financial Officer Oct 1, 2016 100%
Maurice Washington Individual Corporate DirectorBoard Member May 15, 2015
Jared Carter Individual Corporate DirectorBoard Member Jun 5, 2009
Adriana Fralick Individual Corporate DirectorBoard Member May 15, 2015
Walter B Davis Individual Corporate OfficerChief Executive Officer Nov 26, 2012 100%
W-2 Managing EmployeeChiefexecutive Officer Nov 26, 2012 100%

All facility ownership & control disclosures 14

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

FacilityTypeRoleSince
Cambridge Family Health CenterLas Vegas, NV, CCN 291829 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2013
North Las Vegas Family Health CenterNorth Las Vegas, NV, CCN 291824 Federally qualified health center Operational/Managerial Control (100%) May 3, 2013
Eastern Family Medical and Dental CenterLas Vegas, NV, CCN 291837 Federally qualified health center Operational/Managerial Control (100%) Jun 29, 2010
Jackpot Community Health CenterJackpot, NV, CCN 291823 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 1999
Henderson Family Health CenterHenderson, NV, CCN 291849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 18, 2015
Nevada Health Centers Carson City School BasedCarson City, NV, CCN 291854 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 21, 2015
Nevada Health Centers at Virginia CityVirginia City, NV, CCN 291855 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2015
Nevada Children's Health ProjectLas Vegas, NV, CCN 291862 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2018
Nevada Health Centers at EnterpriseLas Vegas, NV, CCN 291863 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 10, 2019
Willow Street Health CenterReno, NV, CCN 291009 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 22, 2023
Mobile Medical Services 1Carson City, NV, CCN 291010 Federally qualified health center 5% Or Greater Direct Ownership Interest Dec 29, 2023
Mobile Dental Services 1Elko, NV, CCN 291011 Federally qualified health center 5% Or Greater Indirect Ownership Interest Dec 1, 2023
Nellis Family Medical & Dental CenterLas Vegas, NV, CCN 291013 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 9, 2024
Pahrump Family Health CenterPahrump, NV, CCN 291014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 8, 2024

Owned or controlled facilities with NPI records 14

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

View all 14

Practitioners & affiliated clinicians

Practitioners 3

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": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1831278720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 RESEARCH WAY",
            "address_2": "ATTN: PAT",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897067913",
            "telephone_number": "775-888-6610",
            "fax_number": "775-888-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 E AMARGOSA FARM RD",
            "city": "AMARGOSA VALLEY",
            "state": "NV",
            "postal_code": "890209735",
            "telephone_number": "775-372-5432",
            "fax_number": "775-372-1303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEVADA HEALTH CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEVADA HEALTH CENTERS, INC.",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "WALTER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "775-888-6610"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NV",
            "license": "291803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831278720",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "DQ468D",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Amargosa Valley Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Amargosa Valley Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amargosa Valley, NV

Sources for this page

Verify at the official NPI Registry.