NPIMap

Organization Active NPI

Southeast Colorado Hospital District

Doing business as Baca County Hospice

  • Community Based Hospice Care Agency
  • Springfield, CO
National Provider Identifier
1083787840
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0332 Issued in CO
Legal business name
SOUTHEAST COLORADO HOSPITAL DISTRICT
Doing business as
Baca County Hospice
Practice address
324 E 9TH Ave
Springfield, CO 81073-1609
Phone
(719) 523-2194
Fax
(719) 523-4575
NPI assigned
Nov 17, 2006
Last updated
Apr 4, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST COLORADO HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Carla Forrest
Title
Him Director
Phone
(719) 523-2125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0332 CO Primary

Addresses

Primary practice location

324 E 9TH Ave
Springfield, CO 81073-1609

Mailing address

373 E 10TH Ave
Springfield, CO 81073-1622
Phone (719) 523-4057

Other identifiers 1

IdentifierTypeStateIssuer
05800271MedicaidCO

Other names 1

  • Baca County Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161031000157 CO Part A Provider - Hospice 6204725138 Practice locations: Springfield, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083787840. Details of each certification follow.

Hospice certification: CCN 061530

Legal name
SOUTHEAST COLORADO HOSPITAL DISTRICT
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 3, 1994
Last certification
Jun 18, 2019
Ownership / control type
Other
Organization structure
OtherNon-profit
Enrollment address
324 E 9TH Ave
Springfield, CO 81073-1609

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Baca County HospiceCCN 061530 · All quality measures
Ownership
Other
Certified
Jun 3, 1994
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Southeast Colorado Hospital9 organizations share this tax ID, including this one
Part of
Southeast Colorado Hospital

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 4

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

NameRoleSinceShare
Colten Smouse Individual Corporate Director Aug 17, 2021
Crystal Rush Individual W-2 Managing EmployeeDirector of Home Health/Hospice Dec 7, 2020
Audrey Kane Individual Operational/Managerial ControlChief Financial Officer Apr 28, 2025
Southeast Colorado Hospital District Organization, Springfield, CO Non-profit 5% Or Greater Direct Ownership Interest Jun 28, 1994

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 3

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

FacilityTypeRoleSince
Southeast Colorado Hospital DistrictSpringfield, CO, CCN 061311 Hospital 5% Or Greater Direct Ownership Interest Mar 1, 2001
Southeast Colorado Hospital DistrictSpringfield, CO, CCN 06Z311 Hospital 5% Or Greater Direct Ownership Interest Mar 1, 2001
Southeast Colorado Hospital District Physicians ClinicSpringfield, CO, CCN 063998 Rural health clinic Operational/Managerial Control Jun 18, 2010

Owned or controlled facilities with NPI records 5

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

Affiliated clinicians 1

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": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1083787840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "373 E 10TH AVE",
            "city": "SPRINGFIELD",
            "state": "CO",
            "postal_code": "810731622",
            "telephone_number": "719-523-4057",
            "fax_number": "719-523-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 E 9TH AVE",
            "city": "SPRINGFIELD",
            "state": "CO",
            "postal_code": "810731609",
            "telephone_number": "719-523-2194",
            "fax_number": "719-523-4575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST COLORADO HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST COLORADO HOSPITAL DISTRICT",
        "enumeration_date": "2006-11-17",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A",
        "authorized_official_last_name": "FORREST",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "HIM DIRECTOR",
        "authorized_official_telephone_number": "719-523-2125"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CO",
            "license": "0332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05800271",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Baca County Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baca County Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, CO

Sources for this page

Verify at the official NPI Registry.