NPIMap

Organization Active NPI

San Bernardino Mountains Community Hospital District

  • Medicare Defined Swing Bed Hospital Unit
  • Lake Arrowhead, CA
National Provider Identifier
1073663662
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
HSP30260I Issued in CA
Legal business name
SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT
Practice address
29101 Hospital Rd
Lake Arrowhead, CA 92352-0070
Phone
(909) 336-3651
Fax
(909) 336-1179
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Ms. Yvonne D Waggener
Title
Cfo
Phone
(909) 336-3651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X HSP30260I CA Primary

Addresses

Primary practice location

29101 Hospital Rd
Lake Arrowhead, CA 92352-0070

Mailing address

PO Box 70
Lake Arrowhead, CA 92352-0070
Phone (909) 336-3651

Other identifiers 1

IdentifierTypeStateIssuer
LTC30260IMedicaidCA

Other names 1

  • Mountains Community Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070919000989 CA Part A Provider - Critical Access Hospital 7012826878 Practice locations: Lake Arrowhead, CA

Hospital certification: CCN 05Z312

Legal name
SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT
Doing business as
MOUNTAINS COMMUNITY HOSPITAL
Organization structure
OtherNon-profit
Incorporated
Mar 13, 1967 in CA
Enrollment address
29101 Hospital Rd
Lake Arrowhead, CA 92352-9706
Other Hospital Practice Location

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).

National Provider Directory

National Provider Directory
Tax ID family
Mountains Community Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

2642 Palo Alto Way
Running Springs, CA 92382
Phone (909) 867-3641

360 E 7th St
Ste C
Upland, CA 91786
Phone (909) 920-9800

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Carmen Hernandez Individual W-2 Managing Employee May 28, 2013
San Bernardino Mountains Community Hospital District Organization, Lake Arrowhead, CA Created for acquisition 5% Or Greater Direct Ownership Interest Feb 11, 2013 100%
Yvonne Waggener Individual Corporate OfficerCfo Mar 1, 2023 100%
Corporate Director Mar 1, 2023

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 4

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

FacilityTypeRoleSince
Mountains Community HospitalLake Arrowhead, CA, CCN 051312 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013
Mountains Community HospitalLake Arrowhead, CA, CCN 555467 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013
Mountains Community HospitalLake Arrowhead, CA, CCN 058535 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013
Running Springs Rural Health ClinicRunning Springs, CA, CCN 058632 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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.

View all 29

Affiliated clinicians 2

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": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1073663662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923520070",
            "telephone_number": "909-336-3651",
            "fax_number": "909-336-1179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29101 HOSPITAL RD",
            "city": "LAKE ARROWHEAD",
            "state": "CA",
            "postal_code": "923520070",
            "telephone_number": "909-336-3651",
            "fax_number": "909-336-1179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN BERNARDINO MOUNTAINS COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "WAGGENER",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "909-336-3651",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "CA",
            "license": "HSP30260I",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC30260I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountains Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountains Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Arrowhead, CA

Sources for this page

Verify at the official NPI Registry.