NPIMap

Organization Active NPI

Syringa General Hospital District C I F

Doing business as Syringa Primary Care Clinic

  • Primary Care Clinic/Center
  • Grangeville, ID
National Provider Identifier
1073802492
Registry record updated Feb 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
18 Issued in ID
Legal business name
SYRINGA GENERAL HOSPITAL DISTRICT C I F
Doing business as
Syringa Primary Care Clinic
Practice address
607 W Main St
Grangeville, ID 83530-1345
Phone
(208) 983-1700
Fax
(208) 983-2114
NPI assigned
Apr 6, 2011
Last updated
Feb 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2025

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

Authorized official

Name
David Paul Applewood
Title
Chief Financial Officer
Phone
(208) 983-1700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 18 ID Primary

Addresses

Primary practice location

607 W Main St
Grangeville, ID 83530-1345

Mailing address

722 W North St
Grangeville, ID 83530-1350
Phone (208) 983-8590

Other names 1

  • Syringa Primary Care Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110323000892 ID Part A Provider - Rural Health Clinic 6800707530 Practice locations: Grangeville, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073802492. Details of each certification follow.

Rural health clinic certification: CCN 138517

Legal name
SYRINGA GENERAL HOSPITAL DISTRICT C I F
Doing business as
SYRINGA HOSPITAL & CLINICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 14, 2013
Last certification
May 14, 2013
Ownership / control type
2A
Organization structure
OtherNon-profit
Enrollment address
722 W North St
Grangeville, ID 83530-1350
Related CCNs
131315

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Syringa General Hosp11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

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
Charlene Boyer Individual W-2 Managing EmployeeCeo Mar 2, 2026
Randall J Nightengale Individual W-2 Managing EmployeeCfo Apr 9, 2026
David E McKnight Individual Corporate DirectorBoard of Directors Jun 24, 2025
James J Paradiso Individual Corporate DirectorBoard of Directors Jun 24, 2025
Logan Staples Individual Corporate DirectorBoard of Directors Feb 25, 2025
Gunther M Williams Individual Corporate DirectorBoard of Directors Jun 24, 2025
Terri Tackett Individual Corporate DirectorBoard of Directors Jun 25, 2024
Jane M Carlson Individual Corporate DirectorBoard Member Jan 1, 2018
Syringa General Hospital District C I F Organization, Grangeville, ID Operational/Managerial Control Jan 1, 2018
Gerald W Zumwalt Individual Corporate DirectorBoard Member Jan 1, 2018
Laura Smith Individual Corporate DirectorBoard of Directors Jun 25, 2019

Owners & managing parties with NPI records 3

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
Syringa General HospitalGrangeville, ID, CCN 131315 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 5, 2007
Syringa General HospitalGrangeville, ID, CCN 13Z315 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1975
Syringa General Hospital HospiceGrangeville, ID, CCN 131534 Hospice Operational/Managerial Control Jan 1, 2018
Syringa Hospital & ClinicsKooskia, ID, CCN 138518 Rural health clinic Operational/Managerial Control Jan 1, 2018

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1302048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739664000000",
    "number": "1073802492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 W NORTH ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301350",
            "telephone_number": "208-983-8590",
            "fax_number": "208-983-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W MAIN ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301345",
            "telephone_number": "208-983-1700",
            "fax_number": "208-983-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYRINGA GENERAL HOSPITAL DISTRICT C I F",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-06",
        "last_updated": "2025-02-16",
        "certification_date": "2025-02-16",
        "status": "A",
        "authorized_official_last_name": "APPLEWOOD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "208-983-1700"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "ID",
            "license": "18",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Syringa Primary Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grangeville, ID

Sources for this page

Verify at the official NPI Registry.