NPIMap

Organization Active NPI

Fallon Medical Complex Inc

  • Critical Access Hospital
  • Baker, MT
National Provider Identifier
1316965346
Registry record updated Oct 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
10663 Issued in MT
Legal business name
FALLON MEDICAL COMPLEX INC
Practice address
202 South 4TH Street West
Baker, MT 59313-0820
Phone
(406) 778-3331
Fax
(406) 778-5155
NPI assigned
Jul 17, 2006
Last updated
Oct 9, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2012

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

Authorized official

Name
Selena R Nelson
Title
Cfo
Phone
(406) 778-5103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 10663 MT Primary

Addresses

Primary practice location

202 South 4TH Street West
Baker, MT 59313-0820

Mailing address

PO Box 820
202 South 4TH Street West
Baker, MT 59313-0820
Phone (406) 778-3331

Other identifiers 2

IdentifierTypeStateIssuer
000060632OtherMTCAH BLUE CROSS
0412360MedicaidMT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000600 MT Part A Provider - Critical Access Hospital 0941119499 Receives reassigned benefits from 15 practitioners
Practice locations: Baker, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316965346. Details of each certification follow.

Hospital certification: CCN 271301

Legal name
FALLON MEDICAL COMPLEX INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2001
Last certification
Oct 27, 2021
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1991 in MT
Enrollment address
202 S 4TH St W
Baker, MT 59313-9156
Other Hospital Practice Location

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Fallon Medical Complex HospitalCCN 271301 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Fallon Medical Complex8 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 10

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

NameRoleSinceShare
Erin M Lutts Individual Corporate DirectorBoard Member Jun 1, 2023
David Kirschten Individual Corporate DirectorBoard Member Jan 1, 2023
Elaine Stanhope Individual Corporate DirectorBoard Member Jan 1, 2023
David E Espeland Individual Corporate OfficerChief Executive Officer Aug 23, 1995
W-2 Managing EmployeeChief Executive Officer Aug 23, 1995
Evelyn K Neary Individual Corporate DirectorBoard Member Jan 1, 2023
Marjorie M Losing Individual Corporate OfficerChief Financial Officer May 1, 2017
W-2 Managing EmployeeChief Financial Officer Jul 18, 2016
Curt Arnell Individual Corporate DirectorBoard Member Mar 2, 2022
Susan L Stevens Individual W-2 Managing EmployeeCredentialing Manager Apr 1, 2017
Michele Gray Individual Corporate DirectorBoard Member Jan 1, 2024
Del Espinosa Individual Corporate DirectorBoard Member Jan 1, 2024

Practitioners & affiliated clinicians

Practitioners 15

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 15

Affiliated clinicians 21

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349740800000",
    "number": "1316965346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 820",
            "address_2": "202 SOUTH 4TH STREET WEST",
            "city": "BAKER",
            "state": "MT",
            "postal_code": "593130820",
            "telephone_number": "406-778-3331",
            "fax_number": "406-778-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 SOUTH 4TH STREET WEST",
            "city": "BAKER",
            "state": "MT",
            "postal_code": "593130820",
            "telephone_number": "406-778-3331",
            "fax_number": "406-778-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLON MEDICAL COMPLEX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2012-10-09",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "SELENA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "406-778-5103"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MT",
            "license": "10663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAH BLUE CROSS",
            "identifier": "000060632",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0412360",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baker, MT

Sources for this page

Verify at the official NPI Registry.