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Cobre Valley Regional Medical Center

Organization Active NPI Rural Health Clinic/Center · Globe, AZ

NPI 1962896167 · NPPES record last updated Apr 21, 2023

Key facts

NPI
1962896167
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
RGH0126 (AZ)
Legal business name
COBRE VALLEY REGIONAL MEDICAL CENTER
Practice address
5994 S Hospital Dr
Globe, AZ 85501-9462
Phone
(928) 425-7108
Fax
(928) 425-7925
NPI assigned
Mar 25, 2015
Organization subpart
No

Authorized official

Name
Frank D Stapleton
Title
Ceo
Phone
(928) 402-1131

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 9

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

Other NPIs with the same Medicare PAC ID 8

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

Corporate family (same tax ID) 12

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

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

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 44

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AZ

Rural health clinic certification: CCN 038506

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 7, 2017
Last certification
Mar 14, 2023
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Mar 29, 1988 in AZ
Enrollment address
5994 S Hospital Dr
Globe, AZ 85501-9462
Related CCNs
031314

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
Jack Bradford
Individual 		Corporate Director
Vice Chairman		 Jun 23, 2022
Jody Daggett
Individual 		Corporate Director
Chief of Medical Staff (Ex Officio)		 Jan 20, 2016
Edward Carpenter
Individual 		Corporate Director
Trustee		 Oct 24, 2006
Nick Renon
Individual 		Corporate Director
Trustee		 Jul 28, 2025
Paula Horn
Individual 		Corporate Director
Secretary		 Feb 22, 2024
Neal Duane Jensen
Individual 		Corporate Director
Ceo (Ex Officio)		 Jul 10, 1998
Alan Osumi
Individual 		Corporate Director
Board Member		 Mar 1, 2015
Robert E Hollis
Individual 		Corporate Director
Treasurer		 Jul 20, 2014
Jendean G Sartain
Individual 		Corporate Director
Trustee		 Mar 23, 2005
Frank Stapleton
Individual 		W-2 Managing Employee
Chief Clinical Operations Officer		 Jan 22, 2002
Fernando Shipley
Individual 		Corporate Director
Board Member		 Aug 1, 2004
Judy Bessee
Individual 		Corporate Director
Chairman		 Feb 28, 2017

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Pleasant Valley Community Medical Center
Young, AZ · CCN 038500		 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 10, 1998

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040312001228 AZ Part B Supplier - Clinic/Group Practice 0648181693 Receives reassigned benefits from 69 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Young, AZ; Tonto Basin, AZ; Kearny, AZ; Globe, AZ; Superior, AZ
O20170502001316 AZ Part a Provider - Rural Health Clinic 0648181693 Practice locations: Globe, AZ

National Provider Directory

Tax ID family
Cobre Valley Community Hospital (13 organizations share this tax ID)

Locations

1134 W US Highway 60
Superior, AZ 85173
Phone (520) 689-2423

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208600000X
Rural Health Clinic/Center 261QR1300X RGH0126 AZ Yes

Addresses

Primary practice location

5994 S Hospital Dr
Globe, AZ 85501-9462

Mailing address

5880 S Hospital Dr
Globe, AZ 85501-9447
Phone (928) 425-3261

Other identifiers

IdentifierTypeStateIssuer
328496MedicaidAZ

Other names

  • Cobre Valley Family Practice Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 21, 2023.

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682035200000",
    "number": "1962896167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5880 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019447",
            "telephone_number": "928-425-3261",
            "fax_number": "928-425-3859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5994 S HOSPITAL DR",
            "city": "GLOBE",
            "state": "AZ",
            "postal_code": "855019462",
            "telephone_number": "928-425-7108",
            "fax_number": "928-425-7925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-25",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "STAPLETON",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-402-1131"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "RGH0126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "328496",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cobre Valley Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Globe, AZ

All providers in Globe, AZ · Rural Health Clinic/Center in Arizona

Sources for this page

Verify at the official NPI Registry.