NPIMap

Organization Active NPI

Southern Mono Health Care District

Doing business as Rural Health Clinic Mammoth Hospital

  • Rural Acute Care Hospital
  • Mammoth Lakes, CA
National Provider Identifier
1053456400
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
240000008 Issued in CA
Legal business name
SOUTHERN MONO HEALTH CARE DISTRICT
Doing business as
Rural Health Clinic Mammoth Hospital
Practice address
85 Sierra Park Rd
Mammoth Lakes, CA 93546-0660
Phone
(760) 934-3311
Fax
(760) 924-4023
NPI assigned
Feb 21, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mrs. Melanie Van Winkle
Title
Chief Financial Offi
Phone
(760) 934-3311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 240000008 CA Primary

Addresses

Primary practice location

85 Sierra Park Rd
Mammoth Lakes, CA 93546-0660

Mailing address

PO Box 660
85 Sierra Park Rd
Mammoth Lakes, CA 93546-0660
Phone (760) 934-3311

Other identifiers 4

IdentifierTypeStateIssuer
HSP30638HMedicaidCA
HAP18523FMedicaidCA
RHM18523FMedicaidCA
HSP40638HMedicaidCA

Other names 1

  • Rural Health Clinic Mammoth Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100804000884 CA Part A Provider - Rural Health Clinic 9830002401 Practice locations: Mammoth Lakes, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053456400. Details of each certification follow.

Rural health clinic certification: CCN 058523

Legal name
SOUTHERN MONO HEALTH CARE DISTRICT
Doing business as
MAMMOTH HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 7, 1995
Last certification
May 29, 2013
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
85 Sierra Park Rd
Mammoth Lakes, CA 93546
Related CCNs
051303

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

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Southern Mono Healthcare District9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Melanie Van Winkle Individual Corporate OfficerCheif Financial Officer Jan 11, 2010
W-2 Managing EmployeeChief Financial Officer Jan 11, 2010
Southern Mono Health Care District Organization, Mammoth Lakes, CA Operational/Managerial Control Feb 1, 2010

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mammoth HospitalMammoth Lakes, CA, CCN 051303 Hospital Operational/Managerial Control Feb 1, 2010

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

NPI Registry JSON

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1053456400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "address_2": "85 SIERRA PARK RD",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935460660",
            "telephone_number": "760-934-3311",
            "fax_number": "760-924-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SIERRA PARK RD",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935460660",
            "telephone_number": "760-934-3311",
            "fax_number": "760-924-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MONO HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "VAN WINKLE",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFI",
        "authorized_official_telephone_number": "760-934-3311",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "CA",
            "license": "240000008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP30638H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP18523F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM18523F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40638H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rural Health Clinic Mammoth Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rural Health Clinic Mammoth Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mammoth Lakes, CA

Sources for this page

Verify at the official NPI Registry.