NPIMap

Organization Active NPI

Banner Churchill Community Hospital

  • General Acute Care Hospital
  • Fallon, NV
National Provider Identifier
1023113115
Registry record updated Apr 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
638HOS-15 Issued in NV
Legal business name
BANNER CHURCHILL COMMUNITY HOSPITAL
Practice address
801 E Williams Ave
Fallon, NV 89406-3052
Phone
(775) 423-3151
Fax
(775) 423-3365
NPI assigned
Sep 13, 2006
Last updated
Apr 3, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2026

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

Authorized official

Name
Dennis Laraway
Title
Cfo
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 638HOS-15 NV Primary

Addresses

Primary practice location

801 E Williams Ave
Fallon, NV 89406-3052

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702
Phone (602) 747-4000

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040701000826 NV Part B Supplier - Clinic/Group Practice 9638080500 Receives reassigned benefits from 29 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fallon, NV; Fernley, NV

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Custer Comm Hosp Rad

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Banner Health

    dba Banner Hospice of Northern Colorado

    • Community Based Hospice Care Agency
    • Greeley, CO
    • NPI 1407409964

    Member Of

    NPD member

Locations

801 E Williams Ave
Ste 3309
Fallon, NV 89406
Phone (775) 867-7706

635 Innovation Dr
Unit 300
Reno, NV 89511
Phone (775) 329-6241

Practitioners & affiliated clinicians

Practitioners 51

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 51

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775174400000",
    "number": "1023113115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702",
            "telephone_number": "602-747-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 E WILLIAMS AVE",
            "city": "FALLON",
            "state": "NV",
            "postal_code": "894063052",
            "telephone_number": "775-423-3151",
            "fax_number": "775-423-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER CHURCHILL COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2006-09-13",
        "last_updated": "2026-04-03",
        "certification_date": "2026-04-03",
        "status": "A",
        "authorized_official_last_name": "LARAWAY",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NV",
            "license": "638HOS-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fallon, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.