NPIMap

Organization Active NPI

Mt Grant General Hospital

  • Rural Health Clinic/Center
  • Hawthorne, NV
National Provider Identifier
1336197086
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
1170RHC-8 Issued in NV
Legal business name
MT GRANT GENERAL HOSPITAL
Practice address
200 South a Street
Hawthorne, NV 89415-1510
Phone
(775) 945-2461
Fax
(775) 945-2359
NPI assigned
May 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Gregory J Schumann
Title
Business Office Manager
Phone
(775) 945-2461

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 1170RHC-8 NV Primary

Addresses

Primary practice location

200 South a Street
Hawthorne, NV 89415-1510

Mailing address

200 South a Street
PO Box 1510
Hawthorne, NV 89415-1510
Phone (775) 945-2461

Other names 1

  • Mt Grant Medical Building Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100426000073 NV Part A Provider - Rural Health Clinic 1951290337 Practice locations: Hawthorne, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336197086. Details of each certification follow.

Rural health clinic certification: CCN 293975

Legal name
MT GRANT GENERAL HOSPITAL
Doing business as
MT GRANT MEDICAL BUILDING
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 4, 1997
Last certification
Aug 6, 2015
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
Jun 7, 1984 in NV
Enrollment address
200 South a Street
Hawthorne, NV 89415-1510
Related CCNs
291300

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).

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
29D0928814Mt Grant Medical Building200 South a St, Hawthorne, NV 89415Provider-performed microscopyMay 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mt Grant General Hospital9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Denise Ferguson Individual Corporate OfficerCeo/Administrator Jun 1, 2022 100%
W-2 Managing EmployeeCeo/Administrator Jun 1, 2022 100%
Mt Grant General Hospital Organization, Hawthorne, NV Other Jun 7, 1984 100%
Sandrae J Lehman Individual Corporate OfficerCfo Feb 28, 2020 100%
W-2 Managing EmployeeCfo Feb 28, 2020 100%

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
Mt Grant General HospitalHawthorne, NV, CCN 291300 Hospital Other (100%) Jun 7, 1984
Mt Grant General HospitalHawthorne, NV, CCN 29Z300 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 1, 1966
Nov 1, 1966
Lefa L Seran SNF Mt GrantHawthorne, NV, CCN 295001 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)
Adp of the SNF		 Nov 1, 1966
Nov 1, 1966
Nov 1, 1966

Owned or controlled facilities with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336197086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SOUTH A STREET",
            "address_2": "PO BOX 1510",
            "city": "HAWTHORNE",
            "state": "NV",
            "postal_code": "894151510",
            "telephone_number": "775-945-2461",
            "fax_number": "775-945-2359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SOUTH A STREET",
            "city": "HAWTHORNE",
            "state": "NV",
            "postal_code": "894151510",
            "telephone_number": "775-945-2461",
            "fax_number": "775-945-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MT GRANT GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHUMANN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "775-945-2461"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NV",
            "license": "1170RHC-8",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt Grant Medical Building",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hawthorne, NV

Sources for this page

Verify at the official NPI Registry.