Central Valley Medical Center
Organization Active NPI Home Health Agency · Nephi, UT
NPI 1104978790 · NPPES record last updated Apr 20, 2008
Key facts
- NPI
- 1104978790
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 467034 (UT)
- Legal business name
- CENTRAL VALLEY MEDICAL CENTER
- Practice address
- 152 West 1500 North
Nephi, UT 84648 - Phone
- (435) 623-3050
- Fax
- (435) 623-3059
- NPI assigned
- Jan 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Shauna L. Archibald, R.N.
- Title
- Executive Director
- Phone
- (435) 623-3050
Owned or controlled facilities with NPI records 3
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 6
Member organizations 2
Practitioners 25
-
Daniel Dennis Alsup Jr., M.D.
-
Brian L Anderson, MD
-
James M Besendorfer, M.D.
-
Joel E Holman, M.D.
-
Marc F Jones, DO
-
Chris Karrasch, M.D.
-
Dallin Richard Kilpack, FNP-C
-
Michael C Peterson, M.D.
-
Jared Jon Pikus, DO,
-
Joshua William Pinson, FNP-C
-
James F Rosenbeck, D.O.
-
Jason Rock Standring, D.O.
-
J David Sule, MD
-
Kristopher Tatton, FNP-C
-
Jerald B Taylor, D.O.
-
Brandon Beck, D.O.
-
Paul Dommer, D.O.
-
Jason Forgeon, MD
-
Jason Neilsen, M.D,
Affiliated clinicians 9
-
Daniel Dennis Alsup Jr., M.D.
-
Brian A Clements, DO
-
Marc F Jones, DO
-
Chris Karrasch, M.D.
-
Dallin Richard Kilpack, FNP-C
-
James F Rosenbeck, D.O.
-
Jason Rock Standring, D.O.
-
J David Sule, MD
-
Jerald B Taylor, D.O.
Medicare Care Compare: Home health agency
- Listed as
- Central Valley Home Health
- Overall star rating
- ★★★★☆ 3.5 of 5
- Ownership
- Proprietary
- Certified
- Nov 16, 1984
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Home health agency certification: CCN 467034
- Legal name
- CENTRAL VALLEY MEDICAL CENTER
- Doing business as
- CENTRAL VALLEY HOME HEALTH
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Nov 16, 1984
- Last certification
- Oct 25, 2018
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 15, 1984 in UT
- Enrollment address
- 152 W 1500 N
Nephi, UT 84648-5520
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Mark R. Stoddard |
Corporate Officer |
Feb 15, 1984 | |
| Corporate Director |
Feb 15, 1984 | ||
| Operational/Managerial Control |
Feb 15, 1984 | ||
| Robert James Guillory |
Corporate Officer |
May 1, 2017 | |
| Operational/Managerial Control |
May 1, 2017 | ||
| Alan Kenison |
Corporate Officer |
Jan 1, 2000 | |
| Corporate Director |
Jan 13, 2010 | ||
| Wendell Brent Davis |
Corporate Officer |
Aug 15, 2016 | |
| Corporate Director |
Aug 15, 2016 | ||
| W-2 Managing Employee |
Aug 15, 2016 | ||
| Operational/Managerial Control |
Aug 16, 2016 | ||
| Mark Chase |
Corporate Director |
Jan 1, 2000 | |
| Timothy M Blackham |
Corporate Director |
Apr 11, 2018 | |
| Leanna Lundell |
Corporate Director |
Apr 11, 2018 | |
| Sue Ann Whitlock |
Corporate Director |
Apr 11, 2018 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Central Valley Medical Center |
Hospital | Operational/Managerial Control | Jan 1, 1985 |
| Central Valley Hospice |
Hospice | 5% Or Greater Direct Ownership Interest | Feb 21, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050628000411 | UT | Part a Provider - Home Health Agency | 2668380460 | Practice locations: Nephi, UT |
National Provider Directory
- Tax ID family
- James M Besendorfer MD
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/26081706-bf97-4a1b-96e4-2d82c3343f85/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 467034 | UT | Yes |
Addresses
Primary practice location
152 West 1500 North
Nephi, UT 84648
Mailing address
152 West 1500 North
Nephi, UT 84648
Phone (435) 623-3050
Other names
- Central Valley Home Health
Other providers in Nephi, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.