NPIMap

Organization Active NPI

Grand River Hospital District

Doing business as Grand River Primary Care

  • Rural Health Clinic/Center
  • Rifle, CO
National Provider Identifier
1124074042
Registry record updated Oct 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRAND RIVER HOSPITAL DISTRICT
Doing business as
Grand River Primary Care
Practice address
501 Airport Rd
Rifle, CO 81650-8510
Phone
(970) 625-1100
NPI assigned
May 25, 2006
Last updated
Oct 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
GRAND RIVER HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2020

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

Authorized official

Name
Mr. James Curtis Coombs
Title
Ceo
Phone
(970) 625-6405

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

501 Airport Rd
Rifle, CO 81650-8510

Mailing address

501 Airport Rd
Rifle, CO 81650-8510
Phone (970) 625-1100

Other identifiers 1

IdentifierTypeStateIssuer
05638523MedicaidCO

Other names 1

  • Grand River Primary Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030529000066 CO Part A Provider - Rural Health Clinic 7113837469 Practice locations: Rifle, CO
O20040310000898 CO Part B Supplier - Clinic/Group Practice 7113837469 Receives reassigned benefits from 116 practitioners
2 other NPIs on this enrollment
Practice locations: Parachute, CO; Rifle, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124074042. Details of each certification follow.

Rural health clinic certification: CCN 063980

Legal name
GRAND RIVER HOSPITAL DISTRICT
Doing business as
GRAND RIVER PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 20, 1994
Last certification
Sep 24, 2025
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Apr 24, 1961 in CO
Enrollment address
501 Airport Rd
2ND Floor
Rifle, CO 81650-8510
Related CCNs
061317

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
06D1054213Grand River Health Primary Care - Rifle501 Airport Rd, Rifle, CO 81650Provider-performed microscopyMay 14, 2028

National Provider Directory

National Provider Directory
Part of
Grand River Hosp District

Locations

501 Airport Rd
Fl 2
Rifle, CO 81650
Phone (970) 625-1100

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Kelly Hilgers Individual W-2 Managing EmployeeAdministrative Director of Clinics Dec 20, 2019
James Coombs Individual Corporate OfficerCeo May 1, 2006
W-2 Managing EmployeeCeo May 1, 2006
Todd Ellis Individual Corporate DirectorBoard Member Jan 19, 2023
Edward Weiss Individual Corporate DirectorBoard President Jun 1, 2019
Sharon M Raggio Individual Corporate DirectorBoard Member May 1, 2010
Raquel Mendizabal Individual Corporate DirectorBoard Member Jun 1, 2019
Grand River Hospital District Organization, Rifle, CO 5% Or Greater Direct Ownership Interest Apr 24, 1966 100%
Jay Rickstrew Individual Corporate DirectorBoard Member Jan 19, 2023
Perry Will Individual Corporate DirectorBoard Member Jan 19, 2023

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 4

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

FacilityTypeRoleSince
Grand River Health Medical CenterRifle, CO, CCN 061317 Hospital Operational/Managerial Control (100%) Apr 24, 1966
Grand River Medical CenterRifle, CO, CCN 06Z317 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 24, 1966
Grand River Health Care CenterRifle, CO, CCN 065381 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Grand River Health Clinic WestParachute, CO, CCN 063996 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1990

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 119

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 119

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604016000000",
    "number": "1124074042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 AIRPORT RD",
            "city": "RIFLE",
            "state": "CO",
            "postal_code": "816508510",
            "telephone_number": "970-625-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 AIRPORT RD",
            "city": "RIFLE",
            "state": "CO",
            "postal_code": "816508510",
            "telephone_number": "970-625-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RIVER HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRAND RIVER HOSPITAL DISTRICT",
        "enumeration_date": "2006-05-25",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A",
        "authorized_official_last_name": "COOMBS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CURTIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-625-6405",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638523",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand River Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rifle, CO

Sources for this page

Verify at the official NPI Registry.