Kremmling Memorial Hospital District
Organization Active NPI Critical Access Hospital · Granby, CO
NPI 1154936987 · NPPES record last updated Jan 27, 2021
Key facts
- NPI
- 1154936987
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- KREMMLING MEMORIAL HOSPITAL DISTRICT
- Practice address
- 1000 Granby Park South
Granby, CO 80446-8900 - Phone
- (970) 887-5800
- Fax
- (970) 887-5891
- NPI assigned
- Sep 9, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- KREMMLING MEMORIAL HOSPITAL DISTRICT
Authorized official
- Name
- Kelly Clasen
- Title
- Sr. Director, Business Operations
- Phone
- (307) 699-2413
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 6
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 16
Related certifications (CCN) 7
Affiliated clinicians 116
-
Nima Aghili, MD
-
Randall Zain Allison, M.D.
-
William B Baker, M.D.
-
Timothy Michael Balise, PA-C
-
Jennifer Bacalla Bernard, M.D.
-
Patrick Bevan, DO
-
Courtney Marie Bhat, M.D.
-
David D Biggs, MD
-
Aaron Kristoffer Black, M.D.
-
Lauren Robin Bliss, PA-C
-
Christopher Cail, PA-C, ATC
-
Karah R Cloxton, MD
-
Thomas C Coburn, M.D.
-
Carmen Cojanu, MD
-
Blaze Cook, MD
-
Nicole Mes Cotter, M.D.
-
Richard B Cunningham, M.D.
-
Sarah Rose Dathe, PA-S
-
Khristin Marie Degli, PA-C
-
Jessica K Devin, MD
Medicare Care Compare: Hospital
- Listed as
- Middle Park Medical Center
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Hospital certification: CCN 061318
- Legal name
- KREMMLING MEMORIAL HOSPITAL DISTRICT
- Doing business as
- MIDDLE PARK MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Apr 1, 2003
- Last certification
- Jun 5, 2023
- Beds
- 25
- Ownership / control type
- Hospital district or authority
- Organization structure
- Other · Non-profit
- Incorporated
- Apr 1, 2003 in CO
- Enrollment address
- 214 South 4TH St.
Middle Park Medical Center, Kremmling
Kremmling, CO 80459-0399
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Mikealena S Horner |
W-2 Managing Employee | Oct 18, 2010 | |
| Jason Cleckler |
Corporate Officer |
Jan 13, 2020 | 50% |
| Kremmling Memorial Hospital District |
Operational/Managerial Control | Mar 1, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061104000225 | CO | Part a Provider - Critical Access Hospital | 7517871544 |
5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kremmling, CO; Granby, CO; Fraser, CO |
National Provider Directory
- Tax ID family
- Kremmling Memorial Hosp
- Part of
- Kremmling Memorial Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | Yes |
Addresses
Primary practice location
1000 Granby Park South
Granby, CO 80446-8900
Mailing address
PO Box 399
Kremmling, CO 80459-0399
Phone (970) 887-5800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05090006 | Medicaid | CO |
Other names
- Middle Park Medical Center - Granby
Other providers in Granby, CO
- Cynthia C James
- Jeffrey a. Lipke, MD PC
- David B Kemp
- Christopher Lee Klockau
- Kremmling Memorial Hospital District
- Kremmling Memorial Hospital District
- Kremmling Memorial Hospital District
- Kremmling Memorial Hospital District
- Leigh Litteer
- Cherie S Lowenberg
All providers in Granby, CO · Critical Access Hospital in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.