NPIMap

Organization Active NPI

Community Hospital Association, Inc.

Doing business as Wickenburg Community Hospital

  • Critical Access Hospital
  • Wickenburg, AZ
National Provider Identifier
1841282852
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
RGH3505 Issued in AZ
Legal business name
COMMUNITY HOSPITAL ASSOCIATION, INC.
Doing business as
Wickenburg Community Hospital
Practice address
520 Rose LN
Wickenburg, AZ 85390-1447
Phone
(928) 684-5421
Fax
(928) 684-5081
NPI assigned
Aug 16, 2005
Last updated
Nov 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Mrs. Jackie Lundblad
Title
Ceo
Phone
(928) 668-1805

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU
Medicare Defined Swing Bed Hospital Unit 275N00000X RGH3505 AZ
Critical Access Hospital 282NC0060X RGH3505 AZ Primary
Critical Access Hospital 282NC0060X AZ

Addresses

Primary practice location

520 Rose LN
Wickenburg, AZ 85390-1447

Mailing address

520 Rose LN
Wickenburg, AZ 85390-1447
Phone (928) 684-5421

Other practice location 1

1395 W Wickenburg Way
Wickenburg, AZ 85390-4231
Phone (928) 668-1838

Other names 1

  • WICKENBURG COMMUNITY HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040616001475 AZ Part B Supplier - Clinic/Group Practice 4981688900 Receives reassigned benefits from 42 practitioners
4 other NPIs on this enrollment
Practice locations: Wittmann, AZ; Wickenburg, AZ; Congress, AZ; Bagdad, AZ
O20061104000489 AZ Part A Provider - Critical Access Hospital 4981688900 Receives reassigned benefits from 87 practitioners
Practice locations: Wickenburg, AZ
O20220524001864 AZ Part A Provider - Critical Access Hospital 4981688900 Receives reassigned benefits from 1 practitioner
Practice locations: Wickenburg, AZ

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1841282852. Details of each certification follow.

Hospital certification: CCN 031300

Legal name
COMMUNITY HOSPITAL ASSOCIATION INC
Doing business as
WICKENBURG COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Nov 1, 2001
Last certification
Apr 30, 2025
Beds
19
Ownership / control type
Other
Most recent change of ownership
Jan 1, 2002 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
520 Rose LN
Wickenburg, AZ 85390-1447

Hospital certification: CCN 03Z300

Legal name
COMMUNITY HOSPITAL ASSOCIATION INC
Doing business as
WICKENBURG COMMUNITY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Aug 21, 1946 in AZ
Enrollment address
520 Rose LN
Wickenburg, AZ 85390-1447
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Wickenburg Community HospitalCCN 031300 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

519 Rose Ln
Ste A
Wickenburg, AZ 85390
Phone (928) 684-4365

32919 N Center St
Ste B
Wittmann, AZ 85361
Phone (928) 668-1833

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Jackie Lundblad Individual Corporate OfficerCeo Feb 1, 2021 100%
W-2 Managing Employee Feb 1, 2021 100%
Operational/Managerial ControlCeo Mar 1, 2021 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Community Hospital Clinic- WittmannWittmann, AZ, CCN 038511 Rural health clinic Operational/Managerial Control (100%) Jun 1, 2017

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 93

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.

View all 93

Affiliated clinicians 210

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 210

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1841282852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 ROSE LN",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853901447",
            "telephone_number": "928-684-5421",
            "fax_number": "928-684-5081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 ROSE LN",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853901447",
            "telephone_number": "928-684-5421",
            "fax_number": "928-684-5081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1395 W Wickenburg Way",
            "address_purpose": "LOCATION",
            "city": "Wickenburg",
            "state": "AZ",
            "postal_code": "853904231",
            "country_code": "US",
            "telephone_number": "928-668-1838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "LUNDBLAD",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-668-1805",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "AZ",
            "license": "RGH3505",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AZ",
            "license": "RGH3505",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "AZ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WICKENBURG COMMUNITY HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WICKENBURG COMMUNITY HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wickenburg, AZ

Sources for this page

Verify at the official NPI Registry.