NPIMap

Organization Active NPI

Boulder City Hospital Inc

Doing business as Boulder City Hospital Swing Bed

  • Critical Access Hospital
  • Boulder City, NV
National Provider Identifier
1124320726
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
633RUH-16 Issued in NV
Legal business name
BOULDER CITY HOSPITAL INC
Doing business as
Boulder City Hospital Swing Bed
Practice address
901 Adams Blvd
Boulder City, NV 89005-2213
Phone
(702) 293-4111
Fax
(702) 294-5732
NPI assigned
Dec 2, 2010
Last updated
Nov 22, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
BOULDER CITY HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

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

Authorized official

Name
Mrs. Frezewed Belete
Title
Controller
Phone
(702) 293-4111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 633RUH-16 NV Primary

Addresses

Primary practice location

901 Adams Blvd
Boulder City, NV 89005-2213

Mailing address

901 Adams Blvd
Boulder City, NV 89005-2213
Phone (702) 293-4111

Other names 1

  • Boulder City Hospital Swing Bed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220803002099 NV Part A Provider - Critical Access Hospital 7618953795 Practice locations: Boulder City, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124320726. Details of each certification follow.

Hospital certification: CCN 29Z309

Legal name
BOULDER CITY HOSPITAL INC
Organization structure
CorporationNon-profit
Incorporated
Apr 15, 1954 in NV
Enrollment address
901 Adams Blvd
Boulder City, NV 89005-2213
Hospital Swing-Bed Unit

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).

National Provider Directory

National Provider Directory
Part of
R Pramod Kumar MD

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Frezewed Belete Individual W-2 Managing EmployeeController Jan 1, 2009
Margaret Caspar Individual OtherPresident Apr 1, 2011
Robert Kenney Individual OtherVice President Jan 1, 2018
Thomas Maher Individual Corporate OfficerCeo Apr 16, 2007
W-2 Managing EmployeeCeo Apr 16, 2007 100%
Douglas Lewis Individual Corporate OfficerCfo Jan 1, 2015
W-2 Managing EmployeeCfo Jan 1, 2015

Practitioners & affiliated clinicians

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1124320726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 ADAMS BLVD",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890052213",
            "telephone_number": "702-293-4111",
            "fax_number": "702-294-5732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 ADAMS BLVD",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890052213",
            "telephone_number": "702-293-4111",
            "fax_number": "702-294-5732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER CITY HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOULDER CITY HOSPITAL INC",
        "enumeration_date": "2010-12-02",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "BELETE",
        "authorized_official_first_name": "FREZEWED",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "702-293-4111",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NV",
            "license": "633RUH-16",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder City Hospital Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boulder City, NV

Sources for this page

Verify at the official NPI Registry.