NPIMap

Organization Active NPI

Boundary Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Bonners Ferry, ID
National Provider Identifier
1316022247
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
43 Issued in ID
Legal business name
BOUNDARY COMMUNITY HOSPITAL
Practice address
6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Phone
(208) 267-4850
Fax
(208) 267-2202
NPI assigned
Oct 26, 2006
Last updated
Jun 28, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
April D Bennett
Title
Ceo
Phone
(208) 267-4850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 43 ID Primary

Addresses

Primary practice location

6640 Kaniksu St
Bonners Ferry, ID 83805-7532

Mailing address

6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Phone (208) 267-4850

Other identifiers 1

IdentifierTypeStateIssuer
1316022247MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071003000166 ID Part A Provider - Critical Access Hospital 3274583406 Practice locations: Bonners Ferry, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316022247. Details of each certification follow.

Hospital certification: CCN 13Z301

Legal name
BOUNDARY COMMUNITY HOSPITAL
Organization structure
GovernmentNon-profit
Enrollment address
6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Boundary County Hospita5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

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
Elden Koon Individual Corporate Director Jan 1, 2008
Boundary Community Hospital Organization, Bonners Ferry, ID Operational/Managerial Control Oct 4, 2007
Paul Hazdovac Individual Corporate Director Jan 1, 2008
April D Bennett Individual Corporate Officer Jun 6, 2022
W-2 Managing EmployeeCeo Jun 6, 2022
Melinda B Smithson Individual W-2 Managing EmployeeCfo Feb 21, 2022

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Boundary Community HospitalBonners Ferry, ID, CCN 131301 Hospital Operational/Managerial Control Oct 4, 2007
Boundary County Nursing HomeBonners Ferry, ID, CCN 135004 Skilled nursing facility Operational/Managerial Control
Trustee of the SNF
Adp of the SNF		 Jan 1, 1966
Jan 1, 1966
Dec 4, 2024
Boundary Community HospitalBonners Ferry, ID, CCN 138521 Rural health clinic Operational/Managerial Control (100%) Jan 1, 2014

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

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": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1316022247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6640 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-4850",
            "fax_number": "208-267-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6640 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-4850",
            "fax_number": "208-267-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNDARY COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-267-4850"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "ID",
            "license": "43",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316022247",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonners Ferry, ID

Sources for this page

Verify at the official NPI Registry.