NPIMap

Organization Active NPI

Cobre Valley Regional Medical Center

Doing business as Kearny Clinic

  • Rural Health Clinic/Center
  • Kearny, AZ
National Provider Identifier
1992967780
Registry record updated Aug 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
H0126 Issued in AZ
Legal business name
COBRE VALLEY REGIONAL MEDICAL CENTER
Doing business as
Kearny Clinic
Practice address
100 S Tilbury Dr
Kearny, AZ 85137
Phone
(520) 363-5573
Fax
(520) 363-5611
NPI assigned
Jul 2, 2008
Last updated
Aug 9, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2018

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

Authorized official

Name
Mr. Frank A Stapleton
Title
Regional Clinics Director
Phone
(928) 402-1131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X H0126 AZ Primary

Addresses

Primary practice location

100 S Tilbury Dr
Kearny, AZ 85137

Mailing address

PO Box 519
Kearny, AZ 85237-0519
Phone (520) 363-5573

Other identifiers 2

IdentifierTypeStateIssuer
1992967780OtherNPI
934437MedicaidAZ

Other names 1

  • Kearny Clinic Doing business as

Medicare participation

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

Enrollment records 2

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
O20081216000609 AZ Part A Provider - Rural Health Clinic 0648181693 Practice locations: Kearny, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992967780. Details of each certification follow.

Rural health clinic certification: CCN 033997

Legal name
COBRE VALLEY REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 4, 2009
Last certification
Mar 3, 2025
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Mar 29, 1988 in AZ
Enrollment address
100 S Tilbury Dr
Kearny, AZ 85137-1218
Related CCNs
031314

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 9

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

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
03D1087755Kearny Clinic100 Tilbury Drive, Kearny, AZ 85137Certificate of waiverAug 10, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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 DirectorVice Chairman Jun 23, 2022
Jody Daggett Individual Operational/Managerial ControlChief of Medical Staff (Ex Officio) Jan 20, 2016
Edward Carpenter Individual Corporate DirectorTrustee Oct 24, 2006
Nick Renon Individual Corporate Director Jul 28, 2025
Paula Horn Individual Corporate DirectorSecretary Feb 22, 2024
Neal Duane Jensen Individual Corporate OfficerCeo Jul 10, 1998
Alan Osumi Individual Corporate Director Mar 1, 2015
Robert E Hollis Individual Corporate DirectorTreasurer Jul 20, 2014
Jendean G Sartain Individual Corporate DirectorTrustee Mar 1, 2005
Fernando Shipley Individual Corporate Director Aug 1, 2004
Judy Bessee Individual Corporate DirectorChairman Feb 28, 2017

Owners & managing parties with NPI records 2

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

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 7

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": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1992967780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 519",
            "city": "KEARNY",
            "state": "AZ",
            "postal_code": "852370519",
            "telephone_number": "520-363-5573",
            "fax_number": "520-363-5611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S TILBURY DR",
            "city": "KEARNY",
            "state": "AZ",
            "postal_code": "85137",
            "telephone_number": "520-363-5573",
            "fax_number": "520-363-5611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COBRE VALLEY REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2018-08-09",
        "status": "A",
        "authorized_official_last_name": "STAPLETON",
        "authorized_official_first_name": "FRANK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "REGIONAL CLINICS DIRECTOR",
        "authorized_official_telephone_number": "928-402-1131",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "AZ",
            "license": "H0126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1992967780",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "934437",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kearny Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kearny Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kearny, AZ

Sources for this page

Verify at the official NPI Registry.