Challis Area Health Center Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Challis, ID
NPI 1013387877 · NPPES record last updated Jul 21, 2020
Key facts
- NPI
- 1013387877
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CHALLIS AREA HEALTH CENTER INCORPORATED
- Practice address
- 611 Clinic Rd
Challis, ID 83226 - Phone
- (208) 879-4351
- Fax
- (208) 879-5216
- NPI assigned
- Oct 5, 2015
- Organization subpart
- No
Authorized official
- Name
- Sharlene Miller
- Title
- Cfo
- Phone
- (208) 879-2883
Practitioners 15
-
Richard F. Paris, M.D.
-
JP Prouty, M.D.
-
Marla Andrews, LCPC
-
Matthew Chad Banks, PA-C
-
Miles Alan Haeberle, PHYSICIAN ASSISTANT
-
Gay M Miremont, LCSW
-
Grace Suyanti Muliawan, PA-C
-
Stephen Max Smith, PA-C
-
Kathryn A Woods, M.D.
-
Kenneth Henry Hyatt, PA-C
-
Janet Merrell, FNP
-
Sharon Rotax, LMSW
-
Crystal Marie Smalley, LCSW-I, LMSW
-
Helen Winegarner, FNP
-
Nancy Jeanne Cayler, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 13D0666680 | Challis Area Health Center | Provider-performed microscopy | Feb 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Federally qualified health center certification: CCN 131872
- Legal name
- CHALLIS AREA HEALTH CENTER INCORPORATED
- Doing business as
- CHALLIS AREA HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 1, 2016
- Last certification
- Sep 1, 2016
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 1, 2015 in ID
- Enrollment address
- 611 Clinic Rd
Challis, ID 83226-4824
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| JD Bennetts |
Operational/Managerial Control | Jan 1, 2016 | |
| Betsy L Doughty |
Operational/Managerial Control |
May 1, 2016 | |
| Matt Cahoon |
Operational/Managerial Control | May 1, 2016 | |
| Stephen D Rembelski |
Corporate Director |
May 1, 2016 | |
| W-2 Managing Employee | May 1, 2016 | ||
| Operational/Managerial Control |
May 1, 2016 | ||
| Raynae Chamberlain |
Operational/Managerial Control | May 1, 2016 | |
| Robert Boren |
Corporate Officer |
May 1, 2016 | |
| Operational/Managerial Control |
May 1, 2016 | ||
| Jenness Butterfield |
Operational/Managerial Control | May 1, 2016 | |
| Corinne Jones |
Corporate Officer |
May 1, 2016 | |
| Operational/Managerial Control |
May 1, 2016 | ||
| Teila Leuzinger |
Operational/Managerial Control | May 1, 2016 | |
| Stephanie Strand |
Operational/Managerial Control | May 5, 2016 | |
| Shelbie Bryant |
Operational/Managerial Control | May 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160919002630 | ID | Part B Supplier - Clinic/Group Practice | 2769779776 |
Receives reassigned benefits from 9 practitioners Practice locations: Challis, ID |
| O20160921000560 | ID | Part a Provider - Federally Qualified Health Center (FQHC) | 2769779776 | Practice locations: Challis, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
611 Clinic Rd
Challis, ID 83226
Mailing address
PO Box 980
Challis, ID 83226-0980
Phone (208) 879-4391
Other providers in Challis, ID
- Marla Andrews
- Matthew Chad Banks
- Challis Area Health Center
- Challis Dental PLLC
- Challis Joint School District #181
- Corrigan Chiropractic PC
- Country Doctor Chartered
- John Edwards Dmochowski
All providers in Challis, ID · Federally Qualified Health Center (FQHC) in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2020. 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.