NPIMap

Organization Active NPI

Basin Clinic Inc

  • Family Medicine Physician
  • Naturita, CO
National Provider Identifier
1114974037
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BASIN CLINIC INC
Practice address
421 Adams St
Naturita, CO 81422-5018
Phone
(970) 865-2665
Fax
(970) 865-2674
NPI assigned
May 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Authorized official

Name
Christina Pierce
Title
Director
Phone
(970) 865-2665

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

421 Adams St
Naturita, CO 81422-5018

Mailing address

PO Box 340
Naturita, CO 81422-0340
Phone (970) 865-2665

Other identifiers 4

IdentifierTypeStateIssuer
020250699OtherEEOIC
C383208OtherCOMEDICARE PART B
BA643081OtherCOANTHEM BLUE CROSS
18434576MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040331000883 CO Part B Supplier - Clinic/Group Practice 9032101068 Receives reassigned benefits from 8 practitioners
Practice locations: Naturita, CO
O20130717000688 CO Part A Provider - Rural Health Clinic 9032101068 Practice locations: Naturita, CO

Rural health clinic certification: CCN 063876

Legal name
BASIN CLINIC INC
Doing business as
BASIN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2013
Last certification
Dec 8, 2023
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jan 31, 1997 in CO
Enrollment address
421 West Adams Street
Naturita, CO 81422-0340

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0644471Basin Clinic, Inc421 W Adams Street, Naturita, CO 81422Provider-performed microscopyJul 29, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22466/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Peggy Case Individual OtherSecretary Feb 1, 2022 14%
Ruth Reams Individual OtherBoard of Directors May 1, 2017 14%
Carolann Boyer Individual OtherBoard of Directors Nov 1, 2021 14%
Lorraine Garvey Individual OtherVice President Jan 1, 2019 14%
Deanna Sheriff Individual OtherTreasurer Nov 20, 2021 14%
Chris L Daniels Individual Corporate DirectorBoard of Directors, President Dec 21, 2021 14%
OtherBoard President Dec 1, 2021 14%
Don Colcord Individual OtherBoard of Directors Oct 1, 2021 14%
Christina D Pierce Individual Corporate Officer Feb 1, 2011
Corporate DirectorClinic Director May 1, 2021 100%
W-2 Managing Employee May 1, 2021 100%

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1114974037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 340",
            "city": "NATURITA",
            "state": "CO",
            "postal_code": "814220340",
            "telephone_number": "970-865-2665",
            "fax_number": "970-865-2674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 ADAMS ST",
            "city": "NATURITA",
            "state": "CO",
            "postal_code": "814225018",
            "telephone_number": "970-865-2665",
            "fax_number": "970-865-2674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASIN CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "970-865-2665"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EEOIC",
            "identifier": "020250699",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "C383208",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS",
            "identifier": "BA643081",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18434576",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naturita, CO

Sources for this page

Verify at the official NPI Registry.