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Kremmling Memorial Hospital District

Organization Active NPI Rural Health Clinic/Center · Walden, CO

NPI 1164064358 · NPPES record last updated Jan 25, 2021

Key facts

NPI
1164064358
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
KREMMLING MEMORIAL HOSPITAL DISTRICT
Practice address
350 McKinley Street
Walden, CO 80480-9708
Phone
(970) 723-4255
Fax
(970) 723-4268
NPI assigned
Oct 9, 2019
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

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

Owners & managing parties with NPI records 5

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

Owned or controlled facilities with NPI records 7

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

Other NPIs on the same Medicare enrollment 1

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).

Corporate family (same tax ID) 16

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

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

Facilities with the same owner 2

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

Practitioners 37

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

View all 37

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CO

Rural health clinic certification: CCN 068518

Legal name
KREMMLING MEMORIAL HOSPITAL DISTRICT
Doing business as
NORTH PARK MEDICAL CENTER-WALDEN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 1, 2012
Last certification
May 18, 2021
Ownership / control type
Non-profit – church related
Organization structure
Other · Non-profit
Enrollment address
350 McKinley Street
North Park Medical Center-Walden
Walden, CO 80480
Related CCNs
061318

All disclosed owners & managing parties 4

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 Employee
Director of Finance		 Feb 1, 2012
Jason Cleckler
Individual 		Corporate Officer
Ceo		 Jan 1, 2020 50%
Mark B Murphy
Individual 		Corporate Director
Board Member		 Oct 18, 2010 100%
Kremmling Memorial Hospital District
Organization · Kremmling, CO 		Operational/Managerial Control Feb 1, 2012 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Middle Park Medical Center
Kremmling, CO · CCN 061318		 Hospital Operational/Managerial Control Mar 1, 2003
Middle Park Health-Grand Lake Clinic
Grand Lake, CO · CCN 063421		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 20, 1973

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20120301000819 CO Part a Provider - Rural Health Clinic 7517871544 1 other NPI on this enrollment
Practice locations: Walden, CO

National Provider Directory

Tax ID family
Kremmling Memorial Hosp (17 organizations share this tax ID)
Part of
Kremmling Memorial Hosp

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

350 McKinley Street
Walden, CO 80480-9708

Mailing address

PO Box 399
Kremmling, CO 80459-0399
Phone (970) 724-3171

Other identifiers

IdentifierTypeStateIssuer
9000143431MedicaidCO

Other names

  • North Park Medical Center - Walden Doing business as

Other providers in Walden, CO

All providers in Walden, CO · Rural Health Clinic/Center in Colorado

Sources for this page

Verify at the official NPI Registry.