Sunrise Community Health
Organization Active NPI Federally Qualified Health Center (FQHC) · Evans, CO
NPI 1295732048 · NPPES record last updated May 29, 2023
Key facts
- NPI
- 1295732048
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SUNRISE COMMUNITY HEALTH
- Practice address
- 2930 11TH Ave
Evans, CO 80620-1011 - Phone
- (970) 353-9403
- Fax
- (970) 353-9906
- NPI assigned
- Jul 7, 2005
- Organization subpart
- No
Authorized official
- Name
- Cathy Wolff
- Title
- Cfo
- Phone
- (970) 346-2546
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 6
Practitioners 68
-
Paula Fae Clark, FNP
-
Hannah Beth Dunn, MD
-
Piotr Malinowski, DNP, APRN, FNP-C
-
Jennifer Smith, PA-C
-
Justin James Walker, M.D.
-
Tyler A Weigang, M.D.
-
Traci Michelle Alvarado, FNP-BC
-
Amanda Bridge, APN
-
Brenda R Campos-Spitze, M.D.
-
Lauren Conner, PA-C
-
Harlan David, PA-C
-
Jonathan Edmunds, PA-C
-
Catherine J Egan, MD
-
Sean Thomas Filipovitz, M.D.
-
Allyssa Funk, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 06D0670312 | Sunrise Monfort Family Clinic | Compliance | Jul 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO
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
- Corporation · Non-profit
- Incorporated
- Mar 23, 1973 in CO
- Enrollment address
- 2930 11TH Ave
Evans, CO 80620-1011
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Mitzi M Moran |
Corporate Director |
Aug 1, 2006 | |
| W-2 Managing Employee | Sep 14, 1996 | 100% | |
| Marilyn Schock |
Corporate Director |
Apr 22, 2013 | |
| Mary C Wolff |
Corporate Officer |
Mar 8, 2023 | |
| W-2 Managing Employee |
Mar 8, 2023 | ||
| Mark Wallace |
Corporate Director | Jul 9, 2007 | |
| Gina Payne |
Corporate Director |
Jan 20, 2013 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Sunrise North Range Clinic |
Federally qualified health center | Operational/Managerial Control | Mar 28, 2005 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
2930 11th Ave
Ste A
Evans, CO 80620
2930 11th Ave
Ste 200
Evans, CO 80620
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | CO | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05638283 | Medicaid | CO |
Other names
- Monfort Family Clinic
Other providers in Evans, CO
- April Stengel
- Haylie Leann Stoltz
- Sunrise Community Health
- Sunrise Community Health
- Sunrise Community Health
- Sunrise Community Health
- Sunrise Community Health
- Sunrise Community Health
- Sunrise Community Health
- Sunrise Community Health
All providers in Evans, CO · Federally Qualified Health Center (FQHC) in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.