NPIMap

Organization Active NPI

Lost Rivers Medical Center

  • Critical Access Hospital
  • Arco, ID
National Provider Identifier
1114925047
Registry record updated May 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
45 Issued in ID
Legal business name
LOST RIVERS MEDICAL CENTER
Practice address
551 Highland Dr
Arco, ID 83213-9771
Phone
(208) 527-8206
Fax
(208) 527-3430
NPI assigned
Jul 13, 2005
Last updated
May 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2017

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

Authorized official

Name
Mr. Brad Huerta
Title
Ceo
Phone
(208) 527-8205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 45 ID Primary

Addresses

Primary practice location

551 Highland Dr
Arco, ID 83213-9771

Mailing address

PO Box 145
Arco, ID 83213-0145
Phone (208) 527-8206

Other identifiers 1

IdentifierTypeStateIssuer
002300900MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080409000117 ID Part A Provider - Critical Access Hospital 7810807427 Receives reassigned benefits from 17 practitioners
Practice locations: Arco, ID
O20220608002575 ID MDPP Supplier - in-Person MDPP Supplier 7810807427 Practice locations: Arco, ID

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1114925047. Details of each certification follow.

Hospital certification: CCN 131324

Legal name
LOST RIVERS MEDICAL CENTER
Doing business as
LOST RIVERS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 29, 2003
Last certification
Mar 9, 2017
Beds
14
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
Apr 16, 1957 in ID
Enrollment address
551 Highland Dr
Arco, ID 83213-5003
Main/Primary Hospital Location

Hospital certification: CCN 130021

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LOST RIVERS DISTRICT HOSPITAL
Certification status
Terminated Involuntary: failure to meet health/safety requirements, Feb 1, 2003
Provider type (POS)
Hospital – Short-term
Participating since
Jan 26, 1976
Last certification
Jul 25, 2002
Beds
14
Ownership / control type
Hospital district or authority
Facility address
551 Highland Drive PO Box 145
Arco, ID 83213

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Lost Rivers Medical CenterCCN 131324 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Lost Rivers Hospital7 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 10

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

NameRoleSinceShare
Bradley Huerta Individual Corporate OfficerCeo Apr 15, 2013 100%
W-2 Managing EmployeeCeo Apr 15, 2013 100%
Jared Lambson Individual Corporate DirectorBoard Member Sep 27, 2023
Herald Jardine Individual Corporate DirectorBoard Member May 15, 2013
Leeann Betzer Individual W-2 Managing EmployeeDirector of Finance Apr 1, 2013 5%
Monica Hampton Individual Corporate DirectorBoard Member May 28, 2025
Larry Tauscher Individual Corporate DirectorBoard Member May 28, 2025
David Callister Individual Corporate DirectorBoard Chairman Jan 29, 2013
Sherlene Traughber Individual Corporate DirectorBoard Member Jun 28, 2023
Howard Wood Individual Corporate DirectorBoard Member Apr 26, 2023
Lost Rivers Medical Center Organization, Arco, ID 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Operational/Managerial Control Dec 1, 1975 100%

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 3

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

FacilityTypeRoleSince
Lost Rivers SwingbedArco, ID, CCN 13Z324 Hospital 5% Or Greater Direct Ownership Interest Jun 25, 2010
Arco ClinicArco, ID, CCN 133981 Rural health clinic Operational/Managerial Control Apr 24, 2008
Mackay ClinicMackay, ID, CCN 133990 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 24, 2014

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 19

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 19

Affiliated clinicians 85

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1114925047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 145",
            "city": "ARCO",
            "state": "ID",
            "postal_code": "832130145",
            "telephone_number": "208-527-8206",
            "fax_number": "208-527-3430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 HIGHLAND DR",
            "city": "ARCO",
            "state": "ID",
            "postal_code": "832139771",
            "telephone_number": "208-527-8206",
            "fax_number": "208-527-3430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOST RIVERS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-13",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "HUERTA",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-527-8205",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "ID",
            "license": "45",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002300900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Arco, ID

Sources for this page

Verify at the official NPI Registry.