NPIMap

Organization Active NPI

Garfield County

Doing business as Bryce Valley Clinic

  • Rural Health Clinic/Center
  • Cannonville, UT
National Provider Identifier
1013119155
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GARFIELD COUNTY
Doing business as
Bryce Valley Clinic
Practice address
25 S Redrock Dr
Cannonville, UT 84718-8001
Phone
(435) 679-8545
NPI assigned
Jun 1, 2007
Last updated
Jun 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Authorized official

Name
Ms. Deann BrownNPI 1497863393
Title
Administrator
Phone
(435) 676-8811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

25 S Redrock Dr
Cannonville, UT 84718-8001

Mailing address

PO Box 30180
Salt Lake City, UT 84130-0180

Other names 1

  • Bryce Valley Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031227000007 UT Part B Supplier - Clinic/Group Practice 6305744459 Receives reassigned benefits from 18 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Panguitch, UT
O20050701000632 UT Part A Provider - Rural Health Clinic 6305744459 Practice locations: Cannonville, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013119155. Details of each certification follow.

Rural health clinic certification: CCN 463981

Legal name
GARFIELD COUNTY
Doing business as
BRYCE VALLEY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 7, 1991
Last certification
Aug 29, 2018
Ownership / control type
2B
Organization structure
GovernmentNon-profit
Incorporated
Jul 1, 2000 in UT
Enrollment address
25 S Redrock Dr
Cannonville, UT 84718-8001
Related CCNs
461333

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Hailie Pollock Individual Corporate OfficerNurse Administrator May 15, 2022
Troy Spring Individual Corporate OfficerVP Revenue Cycle Apr 1, 2022
Mitchell Cloward Individual Corporate OfficerRegion President - Desert Region Jul 24, 2023
Derrick Haslem Individual Corporate DirectorTrustee Jan 1, 2023
Evan Vickers Individual Corporate DirectorTrustee Jan 1, 2023
Ihc Health Services Inc Organization, Salt Lake City, UT Non-profit Operational/Managerial Control Apr 26, 2010
Elizabeth a Beckman Individual Corporate DirectorTrustee Apr 1, 2022
Peter Guzman Individual Corporate DirectorTrustee Dec 4, 2024
Russell Childs Individual Corporate DirectorTrustee Jan 1, 2023
Sylvester N Berube Individual Corporate DirectorTrustee Apr 1, 2022
Garfield County Organization, Panguitch, UT Non-profit 5% Or Greater Direct Ownership Interest Apr 26, 2010 100%
Cyndi Woodbury Gilbert Individual Corporate DirectorTrustee Jan 1, 2023
Danny K Shaw Individual Corporate DirectorTrustee Jan 1, 2023
Nicole Mouskondis Individual Corporate DirectorTrustee Jan 1, 2023
Keith Whitfield Individual Corporate DirectorTrustee Jan 1, 2023
Deann Robinson Brown Individual Corporate OfficerHospital Administrator Apr 3, 2022
W-2 Managing EmployeeAd; Apr 3, 2022
Robert W Allen Individual Corporate DirectorCeo Dec 1, 2022

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Intermountain Health Garfield Memorial HospitalPanguitch, UT, CCN 461333 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017
Intermountain Health Garfield Memorial HospitalPanguitch, UT, CCN 46Z333 Hospital 5% Or Greater Direct Ownership Interest Apr 26, 2010
Garfield Memorial HospitalPanguitch, UT, CCN 463984 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 21, 2010
Garfield CountyCircleville, UT, CCN 463980 Rural health clinic 5% Or Greater Direct Ownership Interest Apr 26, 2010

Owned or controlled facilities with NPI records 3

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

  • Garfield County

    dba Intermountain Health Garfield Memorial Hospital

    • Critical Access Hospital
    • Panguitch, UT
    • NPI 1508836867

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Garfield County

    dba Circleville Clinic

    • Rural Health Clinic/Center
    • Circleville, UT
    • NPI 1649472796

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Garfield County

    dba Garfield Memorial Clinic

    • Rural Health Clinic/Center
    • Panguitch, UT
    • NPI 1760684815

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 31

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 31

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1013119155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30180",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 S REDROCK DR",
            "city": "CANNONVILLE",
            "state": "UT",
            "postal_code": "847188001",
            "telephone_number": "435-679-8545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARFIELD COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "DEANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "435-676-8811",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bryce Valley Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bryce Valley Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cannonville, UT

Sources for this page

Verify at the official NPI Registry.