NPIMap

Organization Active NPI

East Phillips County Hospital District

Doing business as Family Practice of Holyoke

  • Rural Health Clinic/Center
  • Holyoke, CO
National Provider Identifier
1073520375
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Doing business as
Family Practice of Holyoke
Practice address
1001 E Johnson Street
Holyoke, CO 80734-1854
Phone
(970) 854-2500
Fax
(970) 854-3440
NPI assigned
Aug 1, 2006
Last updated
Jan 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST PHILLIPS COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Authorized official

Name
Michael Hassell
Title
Ceo
Phone
(970) 854-2241

Specialties & licenses 1

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

Addresses

Primary practice location

1001 E Johnson Street
Holyoke, CO 80734-1854

Mailing address

1001 E Johnson Street
Holyoke, CO 80734-1854
Phone (970) 854-2500

Other identifiers 3

IdentifierTypeStateIssuer
59725877MedicaidCO
CC8329OtherCORR MCR #
FA231008OtherCOBC/BS PROV #

Other names 1

  • Family Practice of Holyoke Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040331000584 CO Part B Supplier - Clinic/Group Practice 9638161615 Receives reassigned benefits from 47 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Holyoke, CO
O20080409000705 CO Part A Provider - Rural Health Clinic 9638161615 Practice locations: Holyoke, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073520375. Details of each certification follow.

Rural health clinic certification: CCN 063400

Legal name
EAST PHILLIPS COUNTY HOSPITAL DISTRICT
Doing business as
FAMILY PRACTICE OF HOLYOKE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 2001
Last certification
Apr 7, 2025
Ownership / control type
2A
Organization structure
GovernmentNon-profit
Enrollment address
1001 E Johnson St
Holyoke, CO 80734-1854
Related CCNs
061305

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
East Phillips County Hospital District

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
Steve Young Individual Operational/Managerial ControlBoard Member Jan 1, 1993
Christopher J Alvarez Individual Corporate OfficerCfo Sep 5, 2025
W-2 Managing EmployeeAd; Sep 5, 2025
Operational/Managerial ControlCfo Sep 5, 2025
Sheila Gift Individual Operational/Managerial ControlBoard Member Feb 1, 2015
Maribeth Olson Individual W-2 Managing EmployeeAd;Coo/Cno Feb 16, 2026
Operational/Managerial ControlCoo/Cno Feb 16, 2026
Jimmie Bailey Individual Corporate OfficerCco Aug 16, 2021
W-2 Managing EmployeeCco Aug 16, 2021
Operational/Managerial ControlCco Aug 16, 2021
Gary Rahe Individual Operational/Managerial ControlBoard Member May 1, 2008
Michael Hassell Individual Corporate OfficerCeo Nov 7, 2022
W-2 Managing EmployeeCeo Nov 7, 2022
Operational/Managerial ControlCeo Nov 7, 2022
Angela Powell Individual Operational/Managerial ControlBoard Member May 1, 2014
Julie Wiebke Individual Operational/Managerial ControlBoard Member Apr 27, 2021
East Phillips County Hospital District Organization, Holyoke, CO LLC, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Jessie Diamond Individual W-2 Managing EmployeeManager Oct 19, 2019

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Melissa Memorial HospitalHolyoke, CO, CCN 061305 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 11, 1966
Melissa Memorial HospitalHolyoke, CO, CCN 06Z305 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 11, 1966

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1073520375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E JOHNSON STREET",
            "city": "HOLYOKE",
            "state": "CO",
            "postal_code": "807341854",
            "telephone_number": "970-854-2500",
            "fax_number": "970-854-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E JOHNSON STREET",
            "city": "HOLYOKE",
            "state": "CO",
            "postal_code": "807341854",
            "telephone_number": "970-854-2500",
            "fax_number": "970-854-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST PHILLIPS COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST PHILLIPS COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "HASSELL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-854-2241"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59725877",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR #",
            "identifier": "CC8329",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROV #",
            "identifier": "FA231008",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Practice of Holyoke",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Practice of Holyoke",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holyoke, CO

Sources for this page

Verify at the official NPI Registry.