NPIMap

Organization Active NPI

Wayne Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Hanksville, UT
National Provider Identifier
1093863342
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WAYNE COMMUNITY HEALTH CENTERS INC
Practice address
30 South Hwy 95
Hanksville, UT 84734
Phone
(435) 425-3744
Fax
(435) 425-3785
NPI assigned
Jan 5, 2007
Last updated
Nov 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Authorized official

Name
Darci Elmer
Title
Billing Manager
Phone
(435) 425-1104

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

30 South Hwy 95
Hanksville, UT 84734

Mailing address

PO Box 303
Bicknell, UT 84715-0303
Phone (435) 425-3744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030927000000 UT Part A Provider - Federally Qualified Health Center (FQHC) 1254242233 Practice locations: Hanksville, UT
O20040113000649 UT Part B Supplier - Clinic/Group Practice 1254242233 Receives reassigned benefits from 27 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bicknell, UT; Escalante, UT; Hanksville, UT; Salina, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093863342. Details of each certification follow.

Federally qualified health center certification: CCN 461821

Legal name
WAYNE COMMUNITY HEALTH CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 3, 2003
Last certification
Nov 3, 2003
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 15, 1980 in UT
Enrollment address
30 S Hwy 95
Hanksville, UT 84734
Related CCNs
461802

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

Other NPIs with the same Medicare PAC ID 2

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
Tax ID family
Wayne Community HLTH CT7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Stanley Stowe Individual Corporate Director Dec 18, 2019
Christy Peterson Individual Corporate DirectorBoard Member Jan 1, 2000
Patricia Reese Individual Corporate Director Feb 1, 2017
Scott Bigler Individual Corporate Director Aug 23, 2017
Megan B New Individual Corporate Director Jan 27, 2016
Donavan Smith Individual Corporate DirectorCeo May 1, 2023
W-2 Managing EmployeeCeo May 1, 2023
Curtis Whipple Individual Corporate Director May 23, 2018
Mike Riddle Individual Corporate Director Feb 2, 2018
Burke Torgerson Individual Corporate Director Aug 28, 2019
Clint Albrecht Individual Corporate Director Apr 24, 2019
Sally Sprouse Individual Corporate Director May 23, 2018
Donita Pace Individual Corporate Director Aug 23, 2017

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1093863342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 303",
            "city": "BICKNELL",
            "state": "UT",
            "postal_code": "847150303",
            "telephone_number": "435-425-3744",
            "fax_number": "435-425-3785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 SOUTH HWY 95",
            "city": "HANKSVILLE",
            "state": "UT",
            "postal_code": "84734",
            "telephone_number": "435-425-3744",
            "fax_number": "435-425-3785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "ELMER",
        "authorized_official_first_name": "DARCI",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "435-425-1104"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.