NPIMap

Organization Active NPI

Kremmling Memorial Hospital District

  • Rural Health Clinic/Center
  • Granby, CO
National Provider Identifier
1124456629
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KREMMLING MEMORIAL HOSPITAL DISTRICT
Practice address
1000 Granby Park Drive South
Granby, CO 80446-1169
Phone
(970) 724-3442
Fax
(970) 724-9606
NPI assigned
Oct 18, 2013
Organization subpart
Yes
Parent organization
KREMMLING MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Authorized official

Name
Jason Marshall Cleckler
Title
Ceo
Phone
(970) 208-2907

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 010804 CO
Multi-Specialty Clinic/Center 261QM1300X 00.0000156 CO
Multi-Specialty Clinic/Center 261QM1300X 0000156 CO
Rural Health Clinic/Center 261QR1300X CO Primary

Addresses

Primary practice location

1000 Granby Park Drive South
Granby, CO 80446-1169

Mailing address

PO Box 399
Kremmling, CO 80459-0399
Phone (970) 724-3442

Other identifiers 1

IdentifierTypeStateIssuer
9000226213MedicaidCO

Other names 1

  • dba Middle Park Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170324001789 CO Part A Provider - Rural Health Clinic 7517871544 1 other NPI on this enrollment
Practice locations: Granby, CO

Rural health clinic certification: CCN 063416

Legal name
KREMMLING MEMORIAL HOSPITAL DISTRICT
Doing business as
MIDDLE PARK MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 2, 2018
Last certification
Dec 20, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Jun 20, 1973 in CO
Enrollment address
1000 Granby Park Drive South
Granby, CO 80446-1169
Related CCNs
061318

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

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
Kremmling Memorial Hosp17 organizations share this tax ID, including this one
Part of
Kremmling Memorial Hosp

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Mikealena S Horner Individual W-2 Managing EmployeeDirector of Finance Jan 1, 2017
Jason Cleckler Individual Corporate OfficerCeo Jan 3, 2020 50%
Kremmling Memorial Hospital District Board of Directors Organization, Kremmling, CO 5% Or Greater Direct Ownership Interest Jun 20, 1973

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Middle Park Medical CenterKremmling, CO, CCN 061318 Hospital Operational/Managerial Control Mar 1, 2003
North Park Medical Center-WaldenWalden, CO, CCN 068518 Rural health clinic Operational/Managerial Control (100%) Feb 1, 2012
Middle Park Health-Grand Lake ClinicGrand Lake, CO, CCN 063421 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 20, 1973

Owned or controlled facilities with NPI records 8

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1124456629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "KREMMLING",
            "state": "CO",
            "postal_code": "804590399",
            "telephone_number": "970-724-3442",
            "fax_number": "970-724-9606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 GRANBY PARK DRIVE SOUTH",
            "city": "GRANBY",
            "state": "CO",
            "postal_code": "804461169",
            "telephone_number": "970-724-3442",
            "fax_number": "970-724-9606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KREMMLING MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KREMMLING MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2013-10-18",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "CLECKLER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "MARSHALL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-208-2907"
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "CO",
            "license": "010804",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CO",
            "license": "00.0000156",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CO",
            "license": "0000156",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000226213",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba Middle Park Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "dba Middle Park Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Granby, CO

Sources for this page

Verify at the official NPI Registry.