NPIMap

Organization Active NPI

Sunrise Community Health

Doing business as Monfort Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Evans, CO
National Provider Identifier
1295732048
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
Monfort Family Clinic
Practice address
2930 11TH Ave
Evans, CO 80620-1011
Phone
(970) 353-9403
Fax
(970) 353-9906
NPI assigned
Jul 7, 2005
Last updated
May 29, 2023By the provider in NPPES
Organization subpart
No

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 CO Primary

Addresses

Primary practice location

2930 11TH Ave
Evans, CO 80620-1011

Mailing address

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

Other names 1

  • Monfort Family Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040210001043 CO Part A Provider - Federally Qualified Health Center (FQHC) 0648164780 Practice locations: Evans, CO
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295732048. Details of each certification follow.

Federally qualified health center certification: CCN 061801

Legal name
SUNRISE COMMUNITY HEALTH
Doing business as
MONFORT FAMILY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 23, 1973 in CO
Enrollment address
2930 11TH Ave
Evans, CO 80620-1011

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0670312Sunrise Monfort Family Clinic2930 11TH Ave, Evans, CO 80620ComplianceJul 31, 2026

National Provider Directory

National Provider Directory

Locations

2930 11th Ave
Ste 200
Evans, CO 80620

2930 11th Ave
Ste A
Evans, CO 80620

1039 Main St
Unit G
Windsor, CO 80550
Phone (970) 378-7740

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Mitzi M Moran Individual Corporate DirectorCoo Aug 1, 2006
W-2 Managing Employee Sep 14, 1996 100%
Marilyn Schock Individual Corporate DirectorBoard Member Apr 22, 2013
Mary C Wolff Individual Corporate OfficerChief Financial Officer Mar 8, 2023
W-2 Managing EmployeeChief Financial Officer Mar 8, 2023
Mark Wallace Individual Corporate Director Jul 9, 2007
Gina Payne Individual Corporate DirectorBoard Member Jan 20, 2013

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Sunrise North Range ClinicGreeley, CO, CCN 061910 Federally qualified health center Operational/Managerial Control Mar 28, 2005

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 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685318400000",
    "number": "1295732048",
    "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": "2930 11TH AVE",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201011",
            "telephone_number": "970-353-9403",
            "fax_number": "970-353-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "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": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monfort Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monfort Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evans, CO

Sources for this page

Verify at the official NPI Registry.