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Upper Valley Community Health Services Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Rexburg, ID

NPI 1124403258 · NPPES record last updated May 2, 2024

Key facts

NPI
1124403258
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
UPPER VALLEY COMMUNITY HEALTH SERVICES INC
Practice address
72 S 1St E Ste 101
Rexburg, ID 83440-1902
Phone
(208) 356-4900
Fax
(208) 356-3724
NPI assigned
Jul 30, 2015
Organization subpart
No

Authorized official

Name
Lori K Sessions
Title
Ceo
Phone
(208) 624-4100

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 5

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

Other NPIs on the same Medicare enrollment 6

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

Other NPIs with the same Medicare PAC ID 5

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

Facilities with the same owner 4

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

Practitioners 32

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

View all 32

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2100790Grand Peaks Medical
72 S 1St E, Rexburg, ID 83440		ComplianceAug 7, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in ID

Federally qualified health center certification: CCN 131868

Legal name
UPPER VALLEY COMMUNITY HEALTH SERVICES INC
Doing business as
GRAND PEAKS MEDICAL OR GRAND PEAKS BEHAVIORAL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2016
Last certification
Feb 24, 2016
Ownership / control type
Non-profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Nov 30, 2000 in ID
Enrollment address
72 S 1St E
Ste 101
Rexburg, ID 83440-1965

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Trevor Larson
Individual 		Corporate Director
Board Member		 Nov 27, 2023
Richard Law
Individual 		Corporate Director
Board Member		 Sep 1, 2010
Larry Miles Bradley
Individual 		Corporate Director
Behavioral Health Director		 Aug 2, 2017
Aimee Zimmer
Individual 		Corporate Officer
Chief Operations Officer		 Jun 1, 2015 33%
Upper Valley Community Health Services Inc
Organization · Saint Anthony, ID
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Feb 8, 2008
Operational/Managerial Control Feb 8, 2008 100%
Letha Whitmore
Individual 		Corporate Director
Board Member		 Jan 20, 2010
Brad Bybee
Individual 		Corporate Director
Board Member		 Aug 26, 2019
Bernardo Blanco
Individual 		Corporate Director
Board Member		 Oct 24, 2022
Cristine a Walters
Individual 		Corporate Director
Board Member		 Oct 26, 2020
Jacob K Curtis
Individual 		W-2 Managing Employee
MD;		 Jun 1, 2016
Kristy Parkinson
Individual 		W-2 Managing Employee
Billing Manager		 Mar 26, 2015
Brand Hathaway
Individual 		Corporate Officer
Chief Financial Officer		 Aug 13, 2018 33%
Lori Sessions
Individual 		Corporate Officer
Ceo		 Nov 1, 2012 34%
Genavieve Kirkham
Individual 		Corporate Director
Board Member		 Aug 26, 2019
Dustin Parkinson
Individual 		Corporate Director
Board Member		 Aug 27, 2018
Randy Rose
Individual 		Corporate Director
Board Member		 Mar 26, 2012
Lexie Miller
Individual 		Corporate Director
Board of Directors		 Oct 24, 2022
Kerry C Williams
Individual 		Corporate Director
Board Member		 Oct 24, 2022

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Upper Valley Community Health Services Inc
Saint Anthony, ID · CCN 131836		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2007
Grand Peaks Behavioral Health
Saint Anthony, ID · CCN 131878		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 4, 2024
Upper Valley Community Health Services Inc
Idaho Falls, ID · CCN 131044		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2024
Grand Peaks Medical Behavioral Health
Dubois, ID · CCN 131051		 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Nov 1, 2007

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20120611000120 ID Part B Supplier - Clinic/Group Practice 4385725282 Receives reassigned benefits from 33 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Anthony, ID; Rexburg, ID; Idaho Falls, ID; Dubois, ID
O20160304001867 ID Part a Provider - Federally Qualified Health Center (FQHC) 4385725282 Practice locations: Rexburg, ID

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

72 S 1St E Ste 101
Rexburg, ID 83440-1902

Mailing address

PO Box 18
Saint Anthony, ID 83445-0018
Phone (208) 356-4900

Other names

  • Grand Peaks Medical Doing business as

Other providers in Rexburg, ID

All providers in Rexburg, ID · Federally Qualified Health Center (FQHC) in Idaho

Sources for this page

Verify at the official NPI Registry.