NPIMap

Organization Active NPI

North Canyon Medical Center, Inc.

Doing business as North Canyon Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Gooding, ID
National Provider Identifier
1275703241
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
NORTH CANYON MEDICAL CENTER, INC.
Doing business as
North Canyon Medical Center
Practice address
267 North Canyon Drive
Gooding, ID 83330-1858
Phone
(208) 934-4433
Fax
(208) 934-8643
NPI assigned
Mar 6, 2008
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Timothy L Powers
Title
Ceo
Phone
(208) 934-4433

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU Primary
Critical Access Hospital 282NC0060X NU

Addresses

Primary practice location

267 North Canyon Drive
Gooding, ID 83330-1858

Mailing address

267 North Canyon Drive
Gooding, ID 83330-1858
Phone (208) 934-4433

Other identifiers 4

IdentifierTypeStateIssuer
1275703241MedicaidID
138520OtherIDRURAL HEALTH CLINIC
002857200MedicaidID
13Z302OtherIDMEDICARE BILLING NUMBER

Other names 2

  • North Canyon Medical Center Doing business as
  • Partner's In Healthcare,Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081014000345 ID Part A Provider - Critical Access Hospital 0941371439 Practice locations: Gooding, ID
O20090409000304 ID Part B Supplier - Clinic/Group Practice 0941371439 Receives reassigned benefits from 203 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Twin Falls, ID; Mountain Home, ID; Hailey, ID; Jerome, ID; Buhl, ID; Gooding, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275703241. Details of each certification follow.

Hospital certification: CCN 13Z302

Legal name
NORTH CANYON MEDICAL CENTER INC
Doing business as
NORTH CANYON MEDICAL CENTER
Organization structure
CorporationNon-profit
Enrollment address
267 N Canyon Dr
Gooding, ID 83330-5500
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

491 Heritage Dr
Jerome, ID 83338
Phone (208) 644-7500

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Elaine Bryant Individual Corporate Director Feb 2, 2010
Jdee M Adams Individual Corporate OfficerCeo Nov 1, 2021
W-2 Managing EmployeeAd; Nov 1, 2019
Operational/Managerial Control Nov 1, 2019 100%
Lucy C Osborne Individual Corporate Director Nov 23, 1988

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
North Canyon Medical Center IncJerome, ID, CCN 138533 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2021

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 52

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 52

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1275703241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 NORTH CANYON DRIVE",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833301858",
            "telephone_number": "208-934-4433",
            "fax_number": "208-934-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 NORTH CANYON DRIVE",
            "city": "GOODING",
            "state": "ID",
            "postal_code": "833301858",
            "telephone_number": "208-934-4433",
            "fax_number": "208-934-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH CANYON MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-06",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-934-4433"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275703241",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH CLINIC",
            "identifier": "138520",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002857200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE BILLING NUMBER",
            "identifier": "13Z302",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Canyon Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partner's In Healthcare,Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Gooding, ID

Sources for this page

Verify at the official NPI Registry.