NPIMap

Organization Active NPI

St. Lukes Community Hospital

Doing business as St. Luke Community Clinic St. Ignatius

  • Rural Health Clinic/Center
  • St Ignatius, MT
National Provider Identifier
1306911169
Registry record updated Feb 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. LUKES COMMUNITY HOSPITAL
Doing business as
St. Luke Community Clinic St. Ignatius
Practice address
330-6 Tract Lane
St. Ignatius, MT 59865
Phone
(406) 745-2781
Fax
(406) 745-3080
NPI assigned
Nov 21, 2006
Last updated
Feb 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2017

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

Authorized official

Name
Ms. Liane Clairmont
Title
Exuecutive Assistant
Phone
(406) 676-4441

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Physician Assistant 363A00000X
Family Medicine Physician 207Q00000X
Obstetrics & Gynecology Physician 207V00000X

Addresses

Primary practice location

330-6 Tract Lane
St. Ignatius, MT 59865

Mailing address

107 6TH Ave SW
Ronan, MT 59864-2634
Phone (406) 676-4441

Other identifiers 1

IdentifierTypeStateIssuer
0720069MedicaidMT

Other names 1

  • St. Luke Community Clinic St. Ignatius Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031121000276 MT Part B Supplier - Clinic/Group Practice 5496659567 Receives reassigned benefits from 88 practitioners
5 other NPIs on this enrollment
Practice locations: Polson, MT; Ronan, MT
O20040325001376 MT Part A Provider - Rural Health Clinic 5496659567 Practice locations: St Ignatius, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306911169. Details of each certification follow.

Rural health clinic certification: CCN 273988

Legal name
ST LUKES COMMUNITY HOSPITAL
Doing business as
ST. LUKE COMMUNITY CLINIC ST. IGNATIUS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 9, 1998
Last certification
May 9, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 6, 1945 in MT
Enrollment address
330 6 Tracts Way
St Ignatius, MT 59865-7784
Related CCNs
271325

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
St Luke Health Care Net8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Leah Emerson Individual Corporate DirectorBoard Member Jan 1, 2020
Martin M Olsson Individual Corporate DirectorBoard Member Jan 1, 1989
Holly Castor Individual Corporate DirectorBoard Member Jan 1, 1992
Steven J Todd Individual W-2 Managing EmployeeCeo Apr 1, 1998
August T Pavlock Individual Corporate DirectorBoard Member Jul 1, 2012
Philip Grainey Individual Corporate DirectorBoard Member Jan 1, 1985
Jennifer McGinnis Individual Corporate DirectorBoard Member Jan 1, 2011

Practitioners & affiliated clinicians

Practitioners 91

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 91

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487808000000",
    "number": "1306911169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 6TH AVE SW",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598642634",
            "telephone_number": "406-676-4441",
            "fax_number": "406-676-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330-6 TRACT LANE",
            "city": "ST. IGNATIUS",
            "state": "MT",
            "postal_code": "59865",
            "telephone_number": "406-745-2781",
            "fax_number": "406-745-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKES COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2017-02-23",
        "status": "A",
        "authorized_official_last_name": "CLAIRMONT",
        "authorized_official_first_name": "LIANE",
        "authorized_official_title_or_position": "EXUECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "406-676-4441",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0720069",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke Community Clinic St. Ignatius",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Ignatius, MT

Sources for this page

Verify at the official NPI Registry.