NPIMap

Organization Active NPI

Bonner General Hospital, Inc.

Doing business as Bonner Community Hospice

  • Community Based Hospice Care Agency
  • Sandpoint, ID
National Provider Identifier
1073562591
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
BONNER GENERAL HOSPITAL, INC.
Doing business as
Bonner Community Hospice
Practice address
520 N 3Rd Ave
Sandpoint, ID 83864-1507
Phone
(208) 265-1179
Fax
(208) 265-1085
NPI assigned
May 10, 2006
Last updated
May 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Authorized official

Name
John Hennessy
Title
Chief Executive Officer Bonner Gene
Phone
(208) 263-1441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

520 N 3Rd Ave
Sandpoint, ID 83864-1507

Mailing address

PO Box 1353
Sandpoint, ID 83864-0863
Phone (208) 265-1179

Other identifiers 1

IdentifierTypeStateIssuer
002274200MedicaidID

Other names 1

  • Bonner Community Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050531000588 ID Part A Provider - Hospice 4082690466 Practice locations: Sandpoint, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073562591. Details of each certification follow.

Hospice certification: CCN 131514

Legal name
BONNER GENERAL HOSPITAL INC
Doing business as
BONNER COMMUNITY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 22, 1992
Last certification
Mar 17, 2022
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 1949 in ID
Enrollment address
520 N 3Rd Ave
Sandpoint, ID 83864-1507

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Bonner Community HospiceCCN 131514 · All quality measures
Ownership
Non-Profit
Certified
Jul 22, 1992
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Bonner Professional Compounding9 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 13

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

NameRoleSinceShare
John P Hennessy Individual Corporate OfficerCfo Sep 15, 2014
W-2 Managing Employee Sep 15, 2014
Scott a Burgstahler Individual Corporate Director Apr 1, 2012
Jim Frank Individual Corporate Director May 1, 2015
Barton Casey Individual Corporate Director Feb 1, 2016
Bonner General Hospital Inc Organization, Sandpoint, ID Non-profit Operational/Managerial Control Jul 22, 1992
Deirdre Baumgartner Individual W-2 Managing EmployeeBusiness Services Manager Feb 10, 2012
Michelle M Anderson Individual Corporate Director Jul 1, 2016
Shawn Woodward Individual Corporate Director Nov 1, 2016
John Elsaesser Individual Corporate Director Feb 1, 2001
Tami Feyen Individual W-2 Managing EmployeeRN Manager-Home Health & Hospice Feb 10, 2012
Tim Cochran Individual Corporate Director Feb 1, 2002
Sheryl L Rickard Individual Corporate OfficerCeo Feb 10, 2012
W-2 Managing Employee Nov 1, 2004
Thomas L Lawrence Individual Corporate Director Feb 1, 1991

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 20

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 20

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1073562591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1353",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838640863",
            "telephone_number": "208-265-1179",
            "fax_number": "208-265-1085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N 3RD AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641507",
            "telephone_number": "208-265-1179",
            "fax_number": "208-265-1085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNER GENERAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "HENNESSY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER BONNER GENE",
        "authorized_official_telephone_number": "208-263-1441"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002274200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bonner Community Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandpoint, ID

Sources for this page

Verify at the official NPI Registry.