NPIMap

Organization Active NPI

Kit Carson County Health Services District

Doing business as Stratton Medical Clinic

  • Rural Health Clinic/Center
  • Stratton, CO
National Provider Identifier
1124122403
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0905 Issued in CO
Legal business name
KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Doing business as
Stratton Medical Clinic
Practice address
500 Nebraska Ave
Stratton, CO 80836-1366
Phone
(719) 348-4650
Fax
(719) 348-4653
NPI assigned
Sep 8, 2006
Last updated
Feb 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Authorized official

Name
Brenda L Briegel
Title
Manager
Phone
(719) 346-9481

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 0905 CO Primary

Addresses

Primary practice location

500 Nebraska Ave
Stratton, CO 80836-1366

Mailing address

500 Nebraska Ave
Stratton, CO 80836-1366
Phone (719) 348-4650

Other names 1

  • Stratton Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080204000700 CO Part A Provider - Rural Health Clinic 4385637917 Practice locations: Stratton, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124122403. Details of each certification follow.

Rural health clinic certification: CCN 063401

Legal name
KIT CARSON COUNTY HEALTH SERVICES DISTRICT
Doing business as
STRATTON MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 10, 2001
Last certification
Nov 8, 2017
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
500 Nebraska Ave
Stratton, CO 80836-1366
Related CCNs
061313

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).

National Provider Directory

National Provider Directory
Tax ID family
Kit Carson County Health Services District6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

500 Nebraska Ave
Stratton, CO 80836
Phone (719) 348-4650

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Brenda Briegel Individual Corporate DirectorDirector Jan 1, 2000
W-2 Managing EmployeeOutpatient Clinic Director Jan 1, 2000
Operational/Managerial ControlDirector Jan 1, 2000

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1124122403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 NEBRASKA AVE",
            "city": "STRATTON",
            "state": "CO",
            "postal_code": "808361366",
            "telephone_number": "719-348-4650",
            "fax_number": "719-348-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 NEBRASKA AVE",
            "city": "STRATTON",
            "state": "CO",
            "postal_code": "808361366",
            "telephone_number": "719-348-4650",
            "fax_number": "719-348-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIT CARSON COUNTY HEALTH SERVICES DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "BRIEGEL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "719-346-9481"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CO",
            "license": "0905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stratton Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stratton Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stratton, CO

Sources for this page

Verify at the official NPI Registry.