NPIMap

Organization Active NPI

Sunrise Community Health

Doing business as Sunrise North Range

  • Federally Qualified Health Center (FQHC)
  • Greeley, CO
National Provider Identifier
1295041598
Registry record updated May 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SUNRISE COMMUNITY HEALTH
Doing business as
Sunrise North Range
Practice address
1300 N 17TH Ave
Greeley, CO 80631-9584
Phone
(970) 353-9403
Fax
(970) 353-9906
NPI assigned
Aug 24, 2010
Last updated
May 29, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNRISE COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2023

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

Authorized official

Name
Cathy Wolff
Title
Cfo
Phone
(970) 346-2546

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1300 N 17TH Ave
Greeley, CO 80631-9584

Mailing address

2930 11TH Ave
Evans, CO 80620-1011
Phone (970) 353-9403

Other names 1

  • Sunrise North Range Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040329001864 CO Part B Supplier - Clinic/Group Practice 0648164780 Receives reassigned benefits from 70 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Windsor, CO; Loveland, CO; Greeley, CO; Evans, CO
O20101109000888 CO Part A Provider - Federally Qualified Health Center (FQHC) 0648164780 Practice locations: Greeley, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295041598. Details of each certification follow.

Federally qualified health center certification: CCN 061910

Legal name
SUNRISE COMMUNITY HEALTH
Doing business as
SUNRISE NORTH RANGE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 11, 2010
Last certification
Nov 11, 2010
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 1973 in CO
Enrollment address
1300 N 17TH Ave
Greeley, CO 80631-9584

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 8

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

National Provider Directory

National Provider Directory
Tax ID family
Sunrise Community Health22 organizations share this tax ID, including this one
Part of
Sunrise Community Health

Other organizations with this tax ID 21

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

View all 21

Locations

1010 A St
Greeley, CO 80631
Phone (970) 313-0400

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
Sunrise Community Health Organization, Evans, CO Corporation Operational/Managerial Control Mar 28, 2005
Mitzi M Moran Individual Corporate OfficerChief Executive Officer Sep 14, 1998 100%
Operational/Managerial ControlCeo Sep 14, 1998
Mark Wallace Individual W-2 Managing EmployeeChief Clinical Officer Jun 22, 2020

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685318400000",
    "number": "1295041598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 11TH AVE",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201011",
            "telephone_number": "970-353-9403",
            "fax_number": "970-353-9906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N 17TH AVE",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806319584",
            "telephone_number": "970-353-9403",
            "fax_number": "970-353-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNRISE COMMUNITY HEALTH",
        "enumeration_date": "2010-08-24",
        "last_updated": "2023-05-29",
        "certification_date": "2023-05-29",
        "status": "A",
        "authorized_official_last_name": "WOLFF",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "970-346-2546"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sunrise North Range",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greeley, CO

Sources for this page

Verify at the official NPI Registry.