NPIMap

Organization Active NPI

Kremmling Memorial Hospital District

Doing business as North Park Medical Center - Walden

  • Rural Health Clinic/Center
  • Walden, CO
National Provider Identifier
1164064358
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
KREMMLING MEMORIAL HOSPITAL DISTRICT
Doing business as
North Park Medical Center - Walden
Practice address
350 McKinley Street
Walden, CO 80480-9708
Phone
(970) 723-4255
Fax
(970) 723-4268
NPI assigned
Oct 9, 2019
Last updated
Jan 25, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
KREMMLING MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Authorized official

Name
Kelly Clasen
Title
Sr. Director, Business Operations
Phone
(307) 699-2413

Specialties & licenses 1

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

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 1

IdentifierTypeStateIssuer
9000143431MedicaidCO

Other names 1

  • North Park Medical Center - Walden Doing business as

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164064358. Details of each certification follow.

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
OtherNon-profit
Enrollment address
350 McKinley Street
North Park Medical Center-Walden
Walden, CO 80480
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 Hospital17 organizations share this tax ID, including this one
Part of
Kremmling Memorial Hospital

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 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 EmployeeDirector of Finance Feb 1, 2012
Jason Cleckler Individual Corporate OfficerCeo Jan 1, 2020 50%
Mark B Murphy Individual Corporate DirectorBoard Member Oct 18, 2010 100%
Kremmling Memorial Hospital District Organization, Kremmling, CO Operational/Managerial Control Feb 1, 2012 100%

Owners & managing parties with NPI records 5

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

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 CenterKremmling, CO, CCN 061318 Hospital Operational/Managerial Control Mar 1, 2003
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 7

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

Facilities with the same owner 2

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

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": "1570579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1164064358",
    "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": "970-724-3171",
            "fax_number": "970-724-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 MCKINLEY STREET",
            "city": "WALDEN",
            "state": "CO",
            "postal_code": "804809708",
            "telephone_number": "970-723-4255",
            "fax_number": "970-723-4268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KREMMLING MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KREMMLING MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2019-10-09",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "CLASEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "SR. DIRECTOR, BUSINESS OPERATIONS",
        "authorized_official_telephone_number": "307-699-2413"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000143431",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Park Medical Center - Walden",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walden, CO

Sources for this page

Verify at the official NPI Registry.