St. Mary'S Hospital Inc
Organization Active NPI Family Medicine Physician · Cottonwood, ID
NPI 1174577100 · NPPES record last updated Aug 10, 2026
Key facts
- NPI
- 1174577100
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- ST. MARY'S HOSPITAL INC
- Practice address
- 701 Lewiston St
Cottonwood, ID 83522-9750 - Phone
- (208) 962-3267
- Fax
- (208) 962-2313
- NPI assigned
- May 22, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- KOOTENAI HEALTH, INC.
Authorized official
- Name
- Lenne Bonner
- Title
- Ceo
- Phone
- (208) 476-8008
Owners & managing parties with NPI records 4
-
Kelly McGrath, MD
Other NPIs on the same Medicare enrollment 6
Related certifications (CCN) 2
Practitioners 45
-
Briana Sarah Bowden, ANP
-
Dean Easton, M.D.
-
Tema Lynn Jessup, DO
-
Justin Leroy Jones, M.D.
-
Suzanne Rose Kangas, PA-C
-
Kelly McGrath, MD
-
Nagib Chowdhury, M.D
-
Renata Larissa Kesala, D.O.
-
Andre Jawann Sullivan, M.D.
-
Jane A Fore, MD
-
Andrea Krogh, PA-C
-
Ann Lima, MD
-
Haley J Minnehan, MD
-
Seth Rosenthal, P.A.
Affiliated clinicians 117
-
Abeer Arain, M.D., M.P.H
-
Briana Sarah Bowden, ANP
-
Tyler Howard Buckley, M.D.
-
Robert J Burnett, M.D.
-
Michael Todd Burtis, M.D.
-
Stephanie Margaret Carpenter, PMHNP-C
-
Erik F Cooper, CNP
-
Charles Qiming Cui, M.D.
-
Michele Renee Dickison, NP-C
-
Nicole M Dwyer, PA
-
Dean Easton, M.D.
-
Donald Franklin Engles, M.D.
-
Russell L Evans, PA-C
-
Robert Kenneth Fairbanks, M.D.
-
Jane A Fore, MD
-
Samantha Garrison, DNP
-
Margaret A Gehring, FNP
Medicare Care Compare: Hospital
- Listed as
- St Mary'S Hospital
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Hospital certification: CCN 131321
- Legal name
- ST MARYS HOSPITAL INC
- Doing business as
- ST. MARY'S HEALTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Feb 1, 2003
- Last certification
- Mar 8, 2019
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 28, 1995 in ID
- Enrollment address
- 701 Lewiston St
Cottonwood, ID 83522-9750
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Cynthia O'Brien |
Corporate Director |
Apr 1, 2020 | |
| Lenne J Bonner |
Corporate Officer |
Sep 1, 2006 | |
| W-2 Managing Employee |
Sep 1, 2006 | ||
| Rene Forsman |
Corporate Director |
Apr 1, 2020 | |
| Jon Ness |
Other |
Apr 1, 2020 | |
| Leonard Hill |
Corporate Director |
Apr 1, 2020 | |
| Matt Sartini |
Corporate Director |
Apr 1, 2020 | |
| Barbara Jean Glodowski |
Corporate Director |
Apr 1, 2020 | |
| Lisa Maurer |
Corporate Director |
Apr 1, 2020 | |
| Christina Ulmer |
Corporate Director |
Apr 1, 2020 | |
| Clarence J Brunson |
Corporate Director |
Apr 1, 2020 | |
| Kootenai Health, Inc. |
5% Or Greater Direct Ownership Interest | Apr 1, 2020 | 100% |
| Jeremy Evans |
Corporate Director |
Apr 1, 2020 | |
| Kimberly Ingram |
Corporate Director |
Apr 1, 2020 | |
| Kelly J McGrath |
Corporate Director |
Apr 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050316000814 | ID | Part B Supplier - Clinic/Group Practice | 5092773168 |
Receives reassigned benefits from 98 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cottonwood, ID; Craigmont, ID; Grangeville, ID; Kamiah, ID; Nezperce, ID |
| O20061104000429 | ID | Part a Provider - Critical Access Hospital | 5092773168 |
Receives reassigned benefits from 55 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cottonwood, ID; Nezperce, ID; Kamiah, ID; Grangeville, ID; Elk City, ID; Craigmont, ID |
National Provider Directory
Locations
36350 Church Rd
Campo, CA 91906
Phone (619) 445-1188
229 S 8th St
St Maries, ID 83861
Phone (208) 245-2591
Interoperability endpoints
- justinjones@smhcvh.medalliesdirect.net
- brianabowden@smhcvh.medalliesdirect.net
- nicholashenrie@smhcvh.medalliesdirect.net
- temajessup@smhcvh.medalliesdirect.net
- thomaswonderlich@smhcvh.medalliesdirect.net
- johntrueblood@smhcvh.medalliesdirect.net
- taresamichna@smhcvh.medalliesdirect.net
- margaret-marypluskal@smhcvh.medalliesdirect.net
- andrewschweitzer@smhcvh.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | ID | Yes | |
| Nurse Practitioner |
363L00000X | ID |
Addresses
Primary practice location
701 Lewiston St
Cottonwood, ID 83522-9750
Mailing address
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-5085
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002283500 | Medicaid | ID | |
| 805066400 | Medicaid | ID |
Other names
- St. Mary's Health
Other providers in Cottonwood, ID
- Jamie Scheffler
- Alvin Jackson Secrest III
- Ronald L Sigler
- Joseph Smith
- St. Mary'S Hospital Inc
- St. Mary'S Hospital Inc
- St. Mary'S Hospital Inc
- St. Mary'S Hospital Inc
- St. Mary'S Hospital Inc
- St. Mary'S Hospital Inc
All providers in Cottonwood, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2026. 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.