NPIMap

Organization Active NPI

Southern Inyo Healthcare District

  • Rural Health Clinic/Center
  • Lone Pine, CA
National Provider Identifier
1063589174
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
240000205 Issued in CA
Legal business name
SOUTHERN INYO HEALTHCARE DISTRICT
Practice address
510 E. Locust
Lone Pine, CA 93545
Phone
(760) 876-1146
Fax
(760) 876-4046
NPI assigned
Nov 30, 2006
Last updated
Jan 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Authorized official

Name
Mr. Brian F. Cotter, R.N.
Title
Ceo
Phone
(760) 876-5501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 240000205 CA Primary

Addresses

Primary practice location

510 E. Locust
Lone Pine, CA 93545

Mailing address

PO Box 1009
Lone Pine, CA 93545
Phone (760) 876-1146

Other names 1

  • Southern Inyo Hospital Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030422000077 CA Part A Provider - Rural Health Clinic 7911816731 1 other NPI on this enrollment
Practice locations: Lone Pine, CA
O20040317000188 CA Part B Supplier - Clinic/Group Practice 7911816731 Receives reassigned benefits from 99 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lone Pine, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063589174. Details of each certification follow.

Rural health clinic certification: CCN 058511

Legal name
SOUTHERN INYO HEALTHCARE DISTRICT
Doing business as
SOUTHERN INYO RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 9, 1995
Last certification
Jul 10, 2013
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Incorporated
Jul 5, 1949 in CA
Enrollment address
510 E Locust Street
Lone Pine, CA 93545-1009
Related CCNs
051302

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).

Other NPIs on the same Medicare enrollment 1

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

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
05D1010801Southern Inyo Rural Health Clinic510 E Locust Street, Lone Pine, CA 93545Certificate of waiverMar 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Southern Inyo Hospical4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Maritza Perkins Individual W-2 Managing EmployeeAdministrative Assistant Dec 8, 2017
Jaque Hickman Individual Corporate DirectorBoard Director Jan 1, 2018 100%
Peter Spiers Individual Contracted Managing EmployeeCeo Jul 30, 2019 100%
Corporate OfficerCeo Jul 30, 2019 100%
Operational/Managerial ControlCeo Jul 30, 2019 100%
Yarenith Hernandez Individual W-2 Managing EmployeeMedical Staff Coordinator Jan 13, 2016
Southern Inyo Healthcare District Organization, Lone Pine, CA Other Jan 1, 1966 100%

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 3

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

FacilityTypeRoleSince
Southern Inyo HospitalLone Pine, CA, CCN 051302 Hospital Operational/Managerial Control (100%) Aug 1, 2019
Southern Inyo HospitalLone Pine, CA, CCN 05Z302 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 1966
Southern Inyo Hospital Skilled Nursing FacilityLone Pine, CA, CCN 555527 Skilled nursing facility Direct Ownership Interest (100%) Jan 1, 1966

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 92

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 92

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1063589174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1009",
            "city": "LONE PINE",
            "state": "CA",
            "postal_code": "93545",
            "telephone_number": "760-876-1146",
            "fax_number": "760-876-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E. LOCUST",
            "city": "LONE PINE",
            "state": "CA",
            "postal_code": "93545",
            "telephone_number": "760-876-1146",
            "fax_number": "760-876-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INYO HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "COTTER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-876-5501",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "240000205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Inyo Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lone Pine, CA

Sources for this page

Verify at the official NPI Registry.