NPIMap

Organization Active NPI

Challis Area Health Center Incorporated

  • Federally Qualified Health Center (FQHC)
  • Challis, ID
National Provider Identifier
1013387877
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jul 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Authorized official

Name
Sharlene Miller
Title
Cfo
Phone
(208) 879-2883

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

611 Clinic Rd
Challis, ID 83226

Mailing address

PO Box 980
Challis, ID 83226-0980
Phone (208) 879-4391

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1013387877. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 1, 2015 in ID
Enrollment address
611 Clinic Rd
Challis, ID 83226-4824

Rural health clinic certification: CCN 133832

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CHALLIS AREA HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 6, 1995
Last certification
Jun 10, 2003
Ownership / control type
Non-profit – church related
Facility address
611 Clinic Road
Challis, ID 83226

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
13D0666680Challis Area Health Center611 Clinic Rd, Challis, ID 83226Provider-performed microscopyFeb 3, 2027

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
JD Bennetts Individual Operational/Managerial Control Jan 1, 2016
Betsy L Doughty Individual Operational/Managerial ControlBoard Member May 1, 2016
Matt Cahoon Individual Operational/Managerial Control May 1, 2016
Stephen D Rembelski Individual Corporate DirectorExecutive Director May 1, 2016
W-2 Managing Employee May 1, 2016
Operational/Managerial ControlExecutive Director May 1, 2016
Raynae Chamberlain Individual Operational/Managerial Control May 1, 2016
Robert Boren Individual Corporate OfficerVice Chairman / Board Member May 1, 2016
Operational/Managerial ControlVice Chairman / Board Member May 1, 2016
Jenness Butterfield Individual Operational/Managerial Control May 1, 2016
Corinne Jones Individual Corporate OfficerSecretary / Board Member May 1, 2016
Operational/Managerial ControlExecutive Director May 1, 2016
Teila Leuzinger Individual Operational/Managerial Control May 1, 2016
Stephanie Strand Individual Operational/Managerial Control May 5, 2016
Shelbie Bryant Individual Operational/Managerial Control May 1, 2016

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1444003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1013387877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 980",
            "city": "CHALLIS",
            "state": "ID",
            "postal_code": "832260980",
            "telephone_number": "208-879-4391",
            "fax_number": "208-879-5216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 CLINIC RD",
            "city": "CHALLIS",
            "state": "ID",
            "postal_code": "83226",
            "telephone_number": "208-879-4351",
            "fax_number": "208-879-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHALLIS AREA HEALTH CENTER INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-05",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SHARLENE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "208-879-2883"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Challis, ID

Sources for this page

Verify at the official NPI Registry.