NPIMap

Organization Active NPI

St Lukes Community Hospital

  • Critical Access Hospital
  • Ronan, MT
National Provider Identifier
1336213446
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
10834 Issued in MT
Legal business name
ST LUKES COMMUNITY HOSPITAL
Practice address
107 6TH Ave SW
Ronan, MT 59864-2634
Phone
(406) 676-4441
Fax
(406) 676-0835
NPI assigned
Nov 20, 2006
Last updated
Nov 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Mr. Shane H Roberts
Title
Chief Executive Officer
Phone
(406) 676-4441

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X NU
Critical Access Hospital 282NC0060X 10834 MT Primary

Addresses

Primary practice location

107 6TH Ave SW
Ronan, MT 59864-2634

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0412711MedicaidMT

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061104000674 MT Part A Provider - Critical Access Hospital 5496659567 Receives reassigned benefits from 34 practitioners
Practice locations: Ronan, MT
O20071001000249 MT Part A Provider - Critical Access Hospital 5496659567 Practice locations: Ronan, MT

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1336213446. Details of each certification follow.

Hospital certification: CCN 271325

Legal name
ST LUKES COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jun 1, 2002
Last certification
Feb 15, 2024
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Mar 6, 1945 in MT
Enrollment address
107 6TH Ave SW
Ronan, MT 59864-2634
Other Hospital Practice Location

Hospital certification: CCN 27Z325

Legal name
ST LUKES COMMUNITY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Mar 6, 1945 in MT
Enrollment address
107 6TH Ave SW
Ronan, MT 59864-2634

Hospital certification: CCN 270019

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
ST LUKE COMMUNITY HOSPITAL
Certification status
Terminated Other: provider status change, May 31, 2002
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 9, 2001
Beds
24
Ownership / control type
Other
Facility address
107 6TH Ave SW
Ronan, MT 59864

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
St Luke Community HospitalCCN 271325 · 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
St Luke Community Hospital8 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 Director Jan 1, 2022
Martin M Olsson Individual Corporate Director Jan 1, 1989
Holly Castor Individual Corporate Director Jan 1, 1992
Steven J Todd Individual Corporate Director Sep 1, 2013
W-2 Managing Employee Sep 1, 2005
W-2 Managing Employee Sep 1, 2013
August T Pavlock Individual Corporate Director Jul 1, 2012
Philip Grainey Individual Corporate Director Jan 1, 1986
Corporate Director Jan 1, 1989
Jennifer McGinnis Individual Corporate Director Jan 1, 1992
Corporate Director Jan 1, 2011

Practitioners & affiliated clinicians

Practitioners 35

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 35

Affiliated clinicians 159

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

View all 159

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1336213446",
    "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": "107 6TH AVE SW",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598642634",
            "telephone_number": "406-676-4441",
            "fax_number": "406-676-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST LUKES COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "SHANE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "406-676-4441",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MT",
            "license": "10834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0412711",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ronan, MT

Sources for this page

Verify at the official NPI Registry.