| Santa Rosa Health Center | |
|
Federal Route 15, Milepost 12 Sells AZ 85634 | |
| (520) 383-7251 | |
| (520) 383-7216 |
| Full Name | Santa Rosa Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | Federal Route 15, Milepost 12, Sells, Arizona |
| Authorized Official Name and Position | Diane Shanley (DEPUTY CEO) |
| Authorized Official Contact | 5203837285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Santa Rosa Health Center 7900 S J Stock Rd Tucson AZ 85746-7012 Ph: (520) 295-2546 | Santa Rosa Health Center Federal Route 15, Milepost 12 Sells AZ 85634 Ph: (520) 383-7251 |
| NPI Number | 1770581639 |
|---|---|
| Provider Enumeration Date | 07/13/2005 |
| Last Update Date | 03/17/2017 |
| Medicare PECOS PAC ID | 0749223485 |
|---|---|
| Medicare Enrollment ID | O20050603000761 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770581639 | NPI | - | NPPES |
| 0327177 | Other | AZ | NACADP# |
| 03D0864300 | Other | AZ | CLIA # |
| 147141-03 | Medicaid | AZ | |
| 1770581639 | Other | AZ | FACILITY PROVIDER # |
| AZ0109850 | Other | AZ | BC/BS AZ DENTAL PROV NO |
| AZ0490080 | Other | AZ | BC/BS AZ PROV NO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP0904X | Clinic/center - Public Health, Federal | (* (Not Available)) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (Arizona) | Secondary |
| Provider Name | Marisa J Werner |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073603205 PECOS PAC ID: 0648175869 Enrollment ID: I20031201000835 |
| Provider Name | Eric A Brody |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730290172 PECOS PAC ID: 0345132171 Enrollment ID: I20040326000884 |
| Provider Name | Raymond R Delisle |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1992885081 PECOS PAC ID: 7416907183 Enrollment ID: I20050131000406 |
| Provider Name | Martin L Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730165671 PECOS PAC ID: 2365492048 Enrollment ID: I20050131000455 |
| Provider Name | Tamiko N Olson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487734687 PECOS PAC ID: 8224088851 Enrollment ID: I20050131000948 |
| Provider Name | James E Olson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982784971 PECOS PAC ID: 7911957550 Enrollment ID: I20050131000994 |
| Provider Name | Martha M Develasco |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1457431561 PECOS PAC ID: 0648221135 Enrollment ID: I20050202000144 |
| Provider Name | Paul D Weintraub |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083793772 PECOS PAC ID: 4183676174 Enrollment ID: I20050217000876 |
| Provider Name | Candice P Speakman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134209323 PECOS PAC ID: 4789636788 Enrollment ID: I20050217000910 |
| Provider Name | Brenda G Neufeld |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609956713 PECOS PAC ID: 6901852003 Enrollment ID: I20050322000788 |
| Provider Name | Leslie P King |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1649201211 PECOS PAC ID: 9032166004 Enrollment ID: I20050401000166 |
| Provider Name | Julia A Hardeman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659359628 PECOS PAC ID: 8325142680 Enrollment ID: I20070327000497 |
| Provider Name | Tyler A Pickrell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558442319 PECOS PAC ID: 5890886733 Enrollment ID: I20070807000835 |
| Provider Name | Andrew J Terranella |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467668145 PECOS PAC ID: 5193812451 Enrollment ID: I20071102000222 |
| Provider Name | Mark W Kleve |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578600045 PECOS PAC ID: 9638250079 Enrollment ID: I20080111000272 |
| Provider Name | Bowen C Tzeng |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952591760 PECOS PAC ID: 5294807079 Enrollment ID: I20080710000757 |
| Provider Name | Ramesh Karra |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891759452 PECOS PAC ID: 5698725851 Enrollment ID: I20090218000333 |
| Provider Name | Kelly R. Yablonski |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467663799 PECOS PAC ID: 8729144159 Enrollment ID: I20090309000665 |
| Provider Name | Regina E Ross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063690014 PECOS PAC ID: 3870640949 Enrollment ID: I20090406000568 |
| Provider Name | Laura H Veal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225364599 PECOS PAC ID: 0446393250 Enrollment ID: I20100202000541 |
| Provider Name | Pearl Kloac |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427143593 PECOS PAC ID: 0648372722 Enrollment ID: I20100317000742 |
| Provider Name | Jennifer H Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366601932 PECOS PAC ID: 5991830499 Enrollment ID: I20100323000713 |
| Provider Name | Brian Miller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194977116 PECOS PAC ID: 4385760297 Enrollment ID: I20100929000153 |
| Provider Name | Autumn E Stevenson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801092747 PECOS PAC ID: 7416130216 Enrollment ID: I20110331000179 |
| Provider Name | Lane C Luna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609080662 PECOS PAC ID: 2062676158 Enrollment ID: I20120621000556 |
| Provider Name | Lars E Krusholm |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1356312532 PECOS PAC ID: 0345406302 Enrollment ID: I20120719000598 |
| Provider Name | Miyoshi Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457684110 PECOS PAC ID: 1850438250 Enrollment ID: I20120917000553 |
| Provider Name | Ginger A Vaughn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558592360 PECOS PAC ID: 3173657848 Enrollment ID: I20130218000275 |
| Provider Name | Stacey Gyenizse |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1568748259 PECOS PAC ID: 5395981617 Enrollment ID: I20130411000148 |
| Provider Name | Amy J Kroeger |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1609023571 PECOS PAC ID: 3274772850 Enrollment ID: I20130611000427 |
| Provider Name | Christopher P Marshall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043278724 PECOS PAC ID: 0446285217 Enrollment ID: I20140228001336 |
| Provider Name | Michael C Diantonio |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528118163 PECOS PAC ID: 4284714429 Enrollment ID: I20140328001437 |
| Provider Name | Helen L Fleischman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619953593 PECOS PAC ID: 6406814383 Enrollment ID: I20141119001868 |
| Provider Name | Reed K Burk |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1023013760 PECOS PAC ID: 6901854579 Enrollment ID: I20141223001452 |
| Provider Name | Aarthi R Jude |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1427473339 PECOS PAC ID: 6608195383 Enrollment ID: I20150430001196 |
| Provider Name | James P Corcoran |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063899540 PECOS PAC ID: 2163742388 Enrollment ID: I20150528002522 |
| Provider Name | Jae Dell M Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215361787 PECOS PAC ID: 8123349610 Enrollment ID: I20150609002469 |
| Provider Name | Johnice J Barajas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063808467 PECOS PAC ID: 5395058903 Enrollment ID: I20150724010850 |
| Provider Name | Marnie G Lamm |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1689992265 PECOS PAC ID: 4981720364 Enrollment ID: I20150807013117 |
| Provider Name | Daniel R Marino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396703757 PECOS PAC ID: 6406871433 Enrollment ID: I20150912000112 |
| Provider Name | Bridget Katherine Peterson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346516531 PECOS PAC ID: 4385877828 Enrollment ID: I20150923000923 |
| Provider Name | Elisabeth Jane Gibbons |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790042182 PECOS PAC ID: 7012158652 Enrollment ID: I20151024000010 |
| Provider Name | Peter A Reding |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043519358 PECOS PAC ID: 0648573121 Enrollment ID: I20160115000865 |
| Provider Name | John R Bennett |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1558385666 PECOS PAC ID: 7012905177 Enrollment ID: I20160401001121 |
| Provider Name | Peter Erigoyen |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1013997667 PECOS PAC ID: 8527037167 Enrollment ID: I20160419000568 |
| Provider Name | Kathleen A Wooten |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1386743532 PECOS PAC ID: 8527366756 Enrollment ID: I20160420002546 |
| Provider Name | Garry W Pohoretsky |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1740326115 PECOS PAC ID: 2860445251 Enrollment ID: I20160426000776 |
| Provider Name | Denise Nicole Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851507610 PECOS PAC ID: 3779626916 Enrollment ID: I20160429000214 |
| Provider Name | Christian D Alvarez |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1851726905 PECOS PAC ID: 3173756913 Enrollment ID: I20160525002478 |
| Provider Name | Rachel A Shorthouse |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1790232288 PECOS PAC ID: 1951680271 Enrollment ID: I20161109001376 |
| Provider Name | Alan R Richardson |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1932451564 PECOS PAC ID: 6709161714 Enrollment ID: I20170314000073 |
| Provider Name | Kenneth H. Fox |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164439873 PECOS PAC ID: 8224154141 Enrollment ID: I20170314000142 |
| Provider Name | Amy H Tsang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679968804 PECOS PAC ID: 7315222932 Enrollment ID: I20170322002235 |
| Provider Name | Kelly M Fath |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194262444 PECOS PAC ID: 2062781842 Enrollment ID: I20170711001242 |
| Provider Name | Brandon A Pettit |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750540985 PECOS PAC ID: 1052584349 Enrollment ID: I20171019002365 |
| Provider Name | Byunyong Choi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558882084 PECOS PAC ID: 3072877075 Enrollment ID: I20180427000307 |
| Provider Name | Jennifer L Harrison-hauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922336866 PECOS PAC ID: 1355605304 Enrollment ID: I20180430000526 |
| Provider Name | Juanita I Jalomo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053714360 PECOS PAC ID: 3870840390 Enrollment ID: I20180716000738 |
| Provider Name | Tiffany Marie Castellano |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063893063 PECOS PAC ID: 4183933351 Enrollment ID: I20190116002298 |
| Provider Name | Edwin Jusino |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1013363993 PECOS PAC ID: 9739426651 Enrollment ID: I20190130000677 |
| Provider Name | Karana M Pierre |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1831194042 PECOS PAC ID: 5496715781 Enrollment ID: I20190528001641 |
| Provider Name | Evelyn T Panzer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174540819 PECOS PAC ID: 9335149129 Enrollment ID: I20200309000150 |
| Provider Name | Tracy Dunn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295077808 PECOS PAC ID: 3870736697 Enrollment ID: I20200414002117 |
| Provider Name | Patrick R Doyle |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1811169329 PECOS PAC ID: 5092868349 Enrollment ID: I20200511000545 |
| Provider Name | Jennifer Phillips |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568808939 PECOS PAC ID: 0840610614 Enrollment ID: I20201015003018 |
| Provider Name | Mark Holley |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801229232 PECOS PAC ID: 3072743186 Enrollment ID: I20201117002943 |
| Provider Name | Hares Banuwal |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1285293100 PECOS PAC ID: 2668707142 Enrollment ID: I20210106000341 |
| Provider Name | Lucia Esmeralda Obregon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548758709 PECOS PAC ID: 2365791142 Enrollment ID: I20210506003062 |
| Provider Name | Jeffrey Rein |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760460323 PECOS PAC ID: 0941483580 Enrollment ID: I20220519001102 |
| Provider Name | Antonio I Fernandez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023181377 PECOS PAC ID: 9739283292 Enrollment ID: I20220728000008 |
| Provider Name | Jeffrey A Duncan |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1669432365 PECOS PAC ID: 0648524454 Enrollment ID: I20220830001792 |
| Provider Name | Lacy Manuelito |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1750844155 PECOS PAC ID: 3870820210 Enrollment ID: I20221005000749 |
| Provider Name | William F Mills |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427045665 PECOS PAC ID: 1254410913 Enrollment ID: I20230310000239 |
| Provider Name | Merlin T Curry |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811334907 PECOS PAC ID: 0042514432 Enrollment ID: I20230322002440 |
| Provider Name | Teresa F Kestler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528155124 PECOS PAC ID: 5496753600 Enrollment ID: I20230330000198 |
| Provider Name | Kristen Felan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255036547 PECOS PAC ID: 1850758954 Enrollment ID: I20230605003400 |
| Provider Name | Alyssa Katz |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1225726474 PECOS PAC ID: 6204294747 Enrollment ID: I20230615001644 |
| Provider Name | Tyrel Fisher |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457813578 PECOS PAC ID: 4688909591 Enrollment ID: I20230823000019 |
| Provider Name | John D Lenahan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437713286 PECOS PAC ID: 1850634502 Enrollment ID: I20230905000311 |
| Provider Name | Samuel Cook |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255990297 PECOS PAC ID: 2062817653 Enrollment ID: I20231017000497 |
| Provider Name | Emma G Cortes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528553674 PECOS PAC ID: 5890140081 Enrollment ID: I20231219003287 |
| Provider Name | Gisele Cesar |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780240044 PECOS PAC ID: 4385029750 Enrollment ID: I20240227002130 |
| Provider Name | Bryan L Johnson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1912934035 PECOS PAC ID: 1052503653 Enrollment ID: I20240603003280 |
Tohono O'odham Nation - Division Of Behavioral Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Highway 86 - Sells Business Loop, Highway 86 - Sells Business Loop, Sells, AZ 85634 Phone: 520-383-6165 Fax: 520-383-5433 |