NPIMap

Organization Active NPI

San Luis Walk-in Clinic, Inc.

  • Rural Health Clinic/Center
  • Somerton, AZ
National Provider Identifier
1972891349
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAN LUIS WALK-IN CLINIC, INC.
Practice address
214 W Main St
Somerton, AZ 85350-6329
Phone
(928) 627-1120
Fax
(928) 722-6113
NPI assigned
Jul 19, 2011
Last updated
Sep 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN LUIS WALK-IN CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Amanda Aguirre, R.D.
Title
President & Ceo
Phone
(928) 315-7910

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

214 W Main St
Somerton, AZ 85350-6329

Mailing address

PO Box 617
Somerton, AZ 85350-0617
Phone (928) 315-7910

Other identifiers 2

IdentifierTypeStateIssuer
943699MedicaidAZ
OTC3969OtherAZADHS LICENSE

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040514000795 AZ Part B Supplier - Clinic/Group Practice 2668361841 Receives reassigned benefits from 88 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Somerton, AZ; Yuma, AZ; San Luis, AZ; Kingman, AZ; Parker, AZ; Lake Havasu City, AZ
O20130912000847 AZ Part A Provider - Rural Health Clinic 2668361841 Practice locations: Somerton, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972891349. Details of each certification follow.

Rural health clinic certification: CCN 033835

Legal name
SAN LUIS WALK-IN CLINIC INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 31, 2014
Last certification
Dec 8, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 2, 2003 in AZ
Enrollment address
214 W Main Street
Somerton, AZ 85350

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
San Luis Walk-in Clinic Inc20 organizations share this tax ID, including this one
Part of
San Luis Walk-in Clinic Inc

Other organizations with this tax ID 19

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

View all 19

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
Arturo Magana Individual Corporate DirectorBoard Member Jan 27, 2019
Howie Jorajuria Individual Corporate DirectorBoard Member Jan 27, 2019
Candice L Orduno Individual Corporate DirectorBoard Member Feb 6, 2009
Gertrudis Medina Individual Corporate DirectorBoard Member Jan 27, 2019
Maria Elena Rodriguez Individual Corporate OfficerClinical Operating Officer Apr 26, 2006
W-2 Managing EmployeeClinical Operating Officer Apr 26, 2006
Christopher Nunez Individual Corporate DirectorBoard Member Aug 28, 2014
Amanda Aguirre Individual Corporate OfficerPresident & Ceo May 1, 2003
Victor Lozano Individual Corporate DirectorBoard Member Jan 27, 2011
Jason Bradley Individual Corporate DirectorBoard Member Apr 25, 2019
Juan M Guerrero Individual Corporate DirectorBoard Member Feb 24, 2016
Ryan Holt Individual Corporate DirectorBoard Member Sep 30, 2021
Eraclio Arvizu Individual Corporate DirectorBoard Member Jan 27, 2019

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
San Luis Walk-in Clinic IncSan Luis, AZ, CCN 033831 Rural health clinic Operational/Managerial Control (100%) May 1, 2003

Owned or controlled facilities with NPI records 2

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

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": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1972891349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 617",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853500617",
            "telephone_number": "928-315-7910",
            "fax_number": "928-722-6113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 W MAIN ST",
            "city": "SOMERTON",
            "state": "AZ",
            "postal_code": "853506329",
            "telephone_number": "928-627-1120",
            "fax_number": "928-722-6113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN LUIS WALK-IN CLINIC, INC.",
        "enumeration_date": "2011-07-19",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "AGUIRRE",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "928-315-7910",
        "authorized_official_credential": "R.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "943699",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS LICENSE",
            "identifier": "OTC3969",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerton, AZ

Sources for this page

Verify at the official NPI Registry.