Active NPI
St. Mary'S Hospital Inc
- Durable Medical Equipment & Medical Supplies
- Cottonwood, ID
National Provider Identifier
1174673552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- ST. MARY'S HOSPITAL INC
- Practice address
- 701 Lewiston St
Cottonwood, ID 83522 - Phone
- (208) 962-3251
- Fax
- (208) 962-3722
- NPI assigned
- Jan 10, 2007
- Organization subpart
- Yes
- Parent organization
- KOOTENAI HEALTH, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lenne Bonner
- Title
- Ceo
- Phone
- (208) 476-8008
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | Primary |
Addresses
Primary practice location
701 Lewiston St
Cottonwood, ID 83522
Mailing address
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-5085
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 805649800 | Medicaid | ID |
Other names 2
- St Mary's Healthwatch
- St. Mary's Health
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
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
- Incorporated
- Dec 28, 1995 in ID
- Enrollment address
- 701 Lewiston St
Cottonwood, ID 83522-9750
Related certifications (CCN) 2
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
- Medicare Defined Swing Bed Hospital Unit
- Cottonwood, ID
- NPI 1669493417
Other NPIs on the same Medicare enrollment 5
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Care Compare: Hospital
Medicare Care Compare- Listed as
- St Mary'S Hospital
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider Directory- Part of
- St Mary'S Clinic
Ownership & related parties
All disclosed owners & managing parties 14
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| 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 |
Owners & managing parties with NPI records 4
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Psychiatry Physician
- Coeur D Alene, ID
- NPI 1174661151
5% Or Greater Direct Ownership Interest
-
- Emergency Medicine Physician
- Coeur D Alene, ID
- NPI 1235288655
5% Or Greater Direct Ownership Interest
Practitioners & affiliated clinicians
Affiliated clinicians 117
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Coeur D Alene, ID
- NPI 1104824150
Hospital
-
- Psychiatric/Mental Health Nurse Practitioner
- Lewiston, ID
- NPI 1629329537
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1786320000000",
"number": "1174673552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2003 KOOTENAI HEALTH WAY",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838146051",
"telephone_number": "208-625-5085",
"fax_number": "208-625-5731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 LEWISTON ST",
"city": "COTTONWOOD",
"state": "ID",
"postal_code": "83522",
"telephone_number": "208-962-3251",
"fax_number": "208-962-3722"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST. MARY'S HOSPITAL INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "KOOTENAI HEALTH, INC.",
"enumeration_date": "2007-01-10",
"last_updated": "2026-08-10",
"certification_date": "2026-08-10",
"status": "A",
"authorized_official_last_name": "BONNER",
"authorized_official_first_name": "LENNE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "208-476-8008"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "805649800",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "St Mary's Healthwatch",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "St. Mary's Health",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cottonwood, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.