Cobre Valley Regional Medical Center
Organization Active NPI Rural Health Clinic/Center · Kearny, AZ
NPI 1992967780 · NPPES record last updated Aug 9, 2018
Key facts
- NPI
- 1992967780
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- H0126 (AZ)
- Legal business name
- COBRE VALLEY REGIONAL MEDICAL CENTER
- Practice address
- 100 S Tilbury Dr
Kearny, AZ 85137 - Phone
- (520) 363-5573
- Fax
- (520) 363-5611
- NPI assigned
- Jul 2, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Frank A Stapleton
- Title
- Regional Clinics Director
- Phone
- (928) 402-1131
Owners & managing parties with NPI records 2
-
Alan K. Osumi, MD
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 8
Related certifications (CCN) 3
Practitioners 42
-
Scott T. Croft, M.D.
-
Nicholas Elkins, D.O.
-
Karen M Gremminger, M.D.
-
Blaine S. Jensen, PA-C
-
Rachel Alt, MD
-
Eericca Michelle Bickley, D.O.
-
Cyrus C Bowers, D.O.
-
Douglas J Campbell, M.D.
-
Tanner Bo Carlson, PA-C
-
Fernando Cruzado, MD
-
Marc Smith Durfee, MSN
-
Mark Ellis, DPM
-
Margo Ruth Flores, NP-C
-
Evan Franke, M.D.
-
Sara Jo Giali, DO
-
Einstein Juma, M.D., MLS
-
Patrick Law, DPM
-
Zachariah McBride, PA-C
-
John William McMahon Jr., M.D.
-
Tyler Peery, FNP
-
Micah David Pullins, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D1087755 | Kearny Clinic | Certificate of waiver | Aug 10, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AZ
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
- Corporation · Non-profit
- Incorporated
- Mar 29, 1988 in AZ
- Enrollment address
- 100 S Tilbury Dr
Kearny, AZ 85137-1218 - Related CCNs
- 031314
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Jack Bradford |
Corporate Director |
Jun 23, 2022 | |
| Jody Daggett |
Operational/Managerial Control |
Jan 20, 2016 | |
| Edward Carpenter |
Corporate Director |
Oct 24, 2006 | |
| Nick Renon |
Corporate Director | Jul 28, 2025 | |
| Paula Horn |
Corporate Director |
Feb 22, 2024 | |
| Neal Duane Jensen |
Corporate Officer |
Jul 10, 1998 | |
| Alan Osumi |
Corporate Director | Mar 1, 2015 | |
| Robert E Hollis |
Corporate Director |
Jul 20, 2014 | |
| Jendean G Sartain |
Corporate Director |
Mar 1, 2005 | |
| Fernando Shipley |
Corporate Director | Aug 1, 2004 | |
| Judy Bessee |
Corporate Director |
Feb 28, 2017 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Pleasant Valley Community Medical Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest | Jul 10, 1998 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | H0126 | AZ | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992967780 | Other | NPI | |
| 934437 | Medicaid | AZ |
Other names
- Kearny Clinic
Other providers in Kearny, AZ
- Katie Dawn Archuleta
- Tiffany Danielle Boyd
- Felix J Celis
- Cobre Valley Regional Medical Center
- Cobre Valley Regional Medical Center
- Jeff Crawford
- Jeff Crawford MD PC
- Kearny Life Center, LLC
- Debra H Pace
- Laurene Pentelbury
All providers in Kearny, AZ · Rural Health Clinic/Center in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 9, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.