NPIMap

Organization Active NPI

Upper Valley Community Health Services Inc

Doing business as Grand Peaks Medical

  • Federally Qualified Health Center (FQHC)
  • Rexburg, ID
National Provider Identifier
1124403258
Registry record updated May 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UPPER VALLEY COMMUNITY HEALTH SERVICES INC
Doing business as
Grand Peaks Medical
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
Last updated
May 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2024

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
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 1

  • Grand Peaks Medical Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124403258. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Nov 30, 2000 in ID
Enrollment address
72 S 1St E
Ste 101
Rexburg, ID 83440-1965

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 6

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
13D2100790Grand Peaks Medical72 S 1St E, Rexburg, ID 83440ComplianceAug 7, 2027

National Provider Directory

National Provider Directory

Locations

72 S 1st E
Rexburg, ID 83440

Ownership & related parties

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 DirectorBoard Member Nov 27, 2023
Richard Law Individual Corporate DirectorBoard Member Sep 1, 2010
Larry Miles Bradley Individual Corporate DirectorBehavioral Health Director Aug 2, 2017
Aimee Zimmer Individual Corporate OfficerChief 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 DirectorBoard Member Jan 20, 2010
Brad Bybee Individual Corporate DirectorBoard Member Aug 26, 2019
Bernardo Blanco Individual Corporate DirectorBoard Member Oct 24, 2022
Cristine a Walters Individual Corporate DirectorBoard Member Oct 26, 2020
Jacob K Curtis Individual W-2 Managing EmployeeMD; Jun 1, 2016
Kristy Parkinson Individual W-2 Managing EmployeeBilling Manager Mar 26, 2015
Brand Hathaway Individual Corporate OfficerChief Financial Officer Aug 13, 2018 33%
Lori Sessions Individual Corporate OfficerCeo Nov 1, 2012 34%
Genavieve Kirkham Individual Corporate DirectorBoard Member Aug 26, 2019
Dustin Parkinson Individual Corporate DirectorBoard Member Aug 27, 2018
Randy Rose Individual Corporate DirectorBoard Member Mar 26, 2012
Lexie Miller Individual Corporate DirectorBoard of Directors Oct 24, 2022
Kerry C Williams Individual Corporate DirectorBoard Member Oct 24, 2022

Owners & managing parties with NPI records 8

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

Owned or controlled facilities with NPI records 5

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 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1124403258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834450018",
            "telephone_number": "208-356-4900",
            "fax_number": "208-624-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72 S 1ST E STE 101",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401902",
            "telephone_number": "208-356-4900",
            "fax_number": "208-356-3724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER VALLEY COMMUNITY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-30",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "SESSIONS",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-624-4100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Peaks Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.