NPIMap

Organization Active NPI

Gritman Medical Center Inc

Doing business as Potlatch Clinic

  • Rural Health Clinic/Center
  • Potlatch, ID
National Provider Identifier
1356438816
Registry record updated Sep 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
39 Issued in ID
Legal business name
GRITMAN MEDICAL CENTER INC
Doing business as
Potlatch Clinic
Practice address
156 6TH St
Potlatch, ID 83855-5008
Phone
(208) 875-2380
Fax
(208) 875-2303
NPI assigned
Oct 6, 2006
Last updated
Sep 14, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2026

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

Authorized official

Name
Mrs. Kara L Besst
Title
Ceo/President
Phone
(208) 882-4511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 39 ID Primary

Addresses

Primary practice location

156 6TH St
Potlatch, ID 83855-5008

Mailing address

PO Box 8007
Moscow, ID 83843-0507
Phone (208) 882-4511

Other identifiers 4

IdentifierTypeStateIssuer
8A612OtherIDBLUE CROSS
805681000MedicaidID
7095847MedicaidWA
000010138303OtherIDREGENCE

Other names 1

  • POTLATCH CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170127002176 ID Part A Provider - Rural Health Clinic 4981984390 Practice locations: Potlatch, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356438816. Details of each certification follow.

Rural health clinic certification: CCN 133995

Legal name
GRITMAN MEDICAL CENTER INC
Doing business as
POTLATCH FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 29, 1999
Last certification
Apr 29, 2004
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 5, 1991 in ID
Enrollment address
156 6TH St
Potlatch, ID 83855-5008
Related CCNs
131327

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
13D0917175Gritman Medical Center Potlatch Clinic156 6TH St, Potlatch, ID 83855Certificate of waiverApr 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gritman Medical Center Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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
Danielle M Lynas Individual Corporate OfficerCfo Jun 1, 2018
W-2 Managing EmployeeCfo Jun 1, 2018
Charles a Jacobson Individual Corporate DirectorBoard Member Jun 1, 2022
Stephen T Busch Individual Corporate DirectorVice Chair Jun 1, 2022
Raymond M Paz Individual Corporate DirectorBoard Chair Jun 1, 2022
Kara Besst Individual Corporate OfficerCeo Nov 22, 2013
Robin Woods Individual Corporate DirectorBoard Chair Jun 1, 2022
Barbara Wells Individual Corporate DirectorBoard Member Jun 1, 2022
Richard Heimsch Individual Corporate DirectorBoard Member Jun 1, 2022
Rula Awwad Rafferty Individual Corporate DirectorBoard Member Jun 1, 2022
Aaron L Ranisate Individual Corporate DirectorBoard Member Jun 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789344000000",
    "number": "1356438816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8007",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838430507",
            "telephone_number": "208-882-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 6TH ST",
            "city": "POTLATCH",
            "state": "ID",
            "postal_code": "838555008",
            "telephone_number": "208-875-2380",
            "fax_number": "208-875-2303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRITMAN MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A",
        "authorized_official_last_name": "BESST",
        "authorized_official_first_name": "KARA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "208-882-4511",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ID",
            "license": "39",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8A612",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805681000",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7095847",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "000010138303",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POTLATCH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Potlatch, ID

Sources for this page

Verify at the official NPI Registry.