NPIMap

Organization Active NPI

Prowers County Hospital District

Doing business as Prowers Medical Center Home Health

  • Home Health Agency
  • Lamar, CO
National Provider Identifier
1174511414
Registry record updated Oct 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
0402RX Issued in CO
Legal business name
PROWERS COUNTY HOSPITAL DISTRICT
Doing business as
Prowers Medical Center Home Health
Practice address
401 Kendall Drive
Lamar, CO 81052-3942
Phone
(719) 336-6881
Fax
(719) 336-7089
NPI assigned
Oct 11, 2005
Last updated
Oct 23, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
PROWERS COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2014

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

Authorized official

Name
Karen L Bryant
Title
C.O.O.
Phone
(719) 336-5147

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X CO
Home Health Agency 251E00000X 0402RX CO Primary

Addresses

Primary practice location

401 Kendall Drive
Lamar, CO 81052-3942

Mailing address

401 Kendall Drive
Lamar, CO 81052-3942
Phone (719) 336-4343

Other identifiers 1

IdentifierTypeStateIssuer
05701925MedicaidCO

Other names 1

  • Prowers Medical Center Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090330000318 CO Part A Provider - Home Health Agency 4486568508 Practice locations: Lamar, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174511414. Details of each certification follow.

Home health agency certification: CCN 067295

Legal name
PROWERS COUNTY HOSPITAL DISTRICT
Doing business as
PROWERS MEDICAL CENTER HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 19, 1997
Last certification
Feb 17, 2021
Ownership / control type
Government Operated
Organization structure
GovernmentNon-profit
Incorporated
in CO
Enrollment address
401 Kendall Drive
Prowers Medical Center Home Health
Lamar, CO 81052-3942
HHA Branch

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Prowers Medical Center Home HealthCCN 067295 · All quality measures
Overall star rating
2.5 of 5
Ownership
Government Operated
Certified
Mar 19, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy

National Provider Directory

National Provider Directory
Tax ID family
PMC Associated Physicia6 organizations share this tax ID, including this one
Part of
PMC Associated Physicia

Other organizations with this tax ID 5

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

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
Lisa a Dodkins Individual W-2 Managing EmployeeRevenue Cycle Director May 13, 2019 5%
Karen Bryant Individual Corporate Director Jan 6, 2009
Prowers County Hospital District Organization, Lamar, CO 5% Or Greater Direct Ownership Interest Dec 1, 2008
Tina Sandoval Individual Corporate OfficerChief Clinical Officer Aug 28, 2017 5%

Owners & managing parties with NPI records 2

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
Prowers Medical CenterLamar, CO, CCN 06Z323 Hospital 5% Or Greater Direct Ownership Interest Jan 6, 2009
Lamar Medical ClinicLamar, CO, CCN 068512 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 26, 2009

Owned or controlled facilities with NPI records 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414022400000",
    "number": "1174511414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 KENDALL DRIVE",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523942",
            "telephone_number": "719-336-4343",
            "fax_number": "719-336-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 KENDALL DRIVE",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523942",
            "telephone_number": "719-336-6881",
            "fax_number": "719-336-7089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROWERS COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROWERS COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2005-10-11",
        "last_updated": "2014-10-23",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "C.O.O.",
        "authorized_official_telephone_number": "719-336-5147"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CO",
            "license": "0402RX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05701925",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prowers Medical Center Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lamar, CO

Sources for this page

Verify at the official NPI Registry.