NPIMap

Organization Active NPI

Trinidad Area Health Association

Doing business as Mt. San Rafael Hospital

  • Critical Access Hospital
  • Trinidad, CO
National Provider Identifier
1184616740
Registry record updated Jan 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0.107.04 Issued in CO
Legal business name
TRINIDAD AREA HEALTH ASSOCIATION
Doing business as
Mt. San Rafael Hospital
Practice address
410 Benedicta Ave
Trinidad, CO 81082-2005
Phone
(719) 846-9213
Fax
(719) 845-4243
NPI assigned
Aug 19, 2005
Last updated
Jan 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2022

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

Authorized official

Name
Kathy Topping
Title
PFS Director
Phone
(719) 845-3168

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU
Critical Access Hospital 282NC0060X 0.107.04 CO Primary

Addresses

Primary practice location

410 Benedicta Ave
Trinidad, CO 81082-2005

Mailing address

410 Benedicta Ave
Trinidad, CO 81082-2005
Phone (719) 846-9213

Other identifiers 1

IdentifierTypeStateIssuer
05033006MedicaidCO

Other names 1

  • Mt. San Rafael Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20031111000178 CO Part B Supplier - Clinic/Group Practice 2769394055 Receives reassigned benefits from 72 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Trinidad, CO
O20101116000953 CO Part A Provider - Critical Access Hospital 2769394055 Receives reassigned benefits from 33 practitioners
Practice locations: Trinidad, CO
O20101220001117 CO Part A Provider - Critical Access Hospital 2769394055 Practice locations: Trinidad, CO
O20181219000723 CO MDPP Supplier - in-Person MDPP Supplier 2769394055 Practice locations: Trinidad, CO

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1184616740. Details of each certification follow.

Hospital certification: CCN 061321

Legal name
TRINIDAD AREA HEALTH ASSOCIATION
Doing business as
MT. SAN RAFAEL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2004
Last certification
May 12, 2022
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Incorporated
Jul 10, 1969 in CO
Enrollment address
410 Benedicta Ave
Mt. San Rafael Hospital
Trinidad, CO 81082-2005
Other Hospital Practice Location

Hospital certification: CCN 06Z321

Legal name
TRINIDAD AREA HEALTH ASSOCIATION
Doing business as
MT. SAN RAFAEL HOSPITAL
Organization structure
OtherNon-profit
Incorporated
Jul 10, 1969 in CO
Enrollment address
410 Benedicta Ave
Mt San Rafael Hospital
Trinidad, CO 81082-2005
Other Hospital Practice Location

Hospital certification: CCN 060033

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MOUNT SAN RAFAEL HOSPITAL
Certification status
Terminated Other: provider status change, Dec 31, 2003
Provider type (POS)
Hospital – Short-term
Participating since
Jan 1, 1969
Last certification
Jun 23, 1994
Beds
70
Ownership / control type
Other
Facility address
410 Benedicta Ave
Trinidad, CO 81082

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

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Mt San Rafael HospitalCCN 061321 · All quality measures
Overall star rating
5 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

328 S Bonaventure Ave
Trinidad, CO 81082
Phone (719) 846-3597

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
Kim Lucero Individual Corporate DirectorCeo Jan 23, 2023
Trinidad Area Health Association Organization, Trinidad, CO Non-profit Operational/Managerial Control Jul 10, 1969 100%
Lori Navarette Individual Corporate Director Jan 23, 2023
Lynda Pachelli Individual W-2 Managing EmployeeExecutive Assistant Jul 1, 2013
W-2 Managing EmployeeExecutive Assistant Jun 28, 2013

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mt San Rafael HospitalTrinidad, CO, CCN 063404 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Nov 1, 2005
Nov 1, 2005

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

Affiliated clinicians 135

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 135

NPI Registry JSON

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

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641427200000",
    "number": "1184616740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 BENEDICTA AVE",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "810822005",
            "telephone_number": "719-846-9213",
            "fax_number": "719-845-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 BENEDICTA AVE",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "810822005",
            "telephone_number": "719-846-9213",
            "fax_number": "719-845-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINIDAD AREA HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-19",
        "last_updated": "2022-01-06",
        "certification_date": "2022-01-06",
        "status": "A",
        "authorized_official_last_name": "TOPPING",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "PFS DIRECTOR",
        "authorized_official_telephone_number": "719-845-3168"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "CO",
            "license": "0.107.04",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05033006",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. San Rafael Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trinidad, CO

Sources for this page

Verify at the official NPI Registry.