Glenns Ferry Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Glenns Ferry, ID
NPI 1376673137 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1376673137
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- GLENNS FERRY HEALTH CENTER, INC.
- Practice address
- 486 W 1St Ave
Glenns Ferry, ID 83623-2701 - Phone
- (208) 366-7416
- Fax
- (208) 587-3324
- NPI assigned
- Mar 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Amber E Jordan
- Title
- Ceo
- Phone
- (208) 696-7157
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 3
Practitioners 27
-
Nicholas J Arbon, LCSW
-
Dawn D Best, FNP
-
Melinda Carpenter, LCPC
-
Adriana Crompton, LCSW
-
Darin K Gere, LCSW
-
Deborah Susan Glasscock, LMSW
-
Katherine Gray, M.D.
-
Jamie Lynn Hendricks, FNP-BC, RN
-
Saad Hijazi, MD
-
Adria Rebekah Probst, LPC, NCC
-
Melanie Gilliland, FNP
-
Stephanie Kaye Vickery, PA-C
-
Mark Eric Merrell, PA-C
-
Quinn M Romeril, PA-C
-
Telicia Marie Saari, PA-C
-
Charlene Clark, FNP
-
Jamie Tisa Coffey-Kelly, LCSW
-
Paulette A Flores, PH.D.
-
Heather Louise King, NP-C
-
Audrey Nicole Thomas, LCSW
-
Harry A Lazarte, M.D.
-
Cynthia Medrano, PMHNP, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Federally qualified health center certification: CCN 131805
- Legal name
- GLENNS FERRY HEALTH CENTER INC
- Doing business as
- DESERT SAGE HEALTH CENTERS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 3, 1988 in ID
- Enrollment address
- 486 West First Avenue
Glenns Ferry, ID 83623-0266
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Paul Shrum |
Corporate Director | Jun 24, 2008 | |
| Darla Rhodes |
Corporate Director |
Aug 1, 2015 | |
| Amber Jordan |
Corporate Officer |
Jul 31, 2024 | |
| Operational/Managerial Control |
Jul 31, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040119000307 | ID | Part B Supplier - Clinic/Group Practice | 5496656894 |
Receives reassigned benefits from 26 practitioners 2 other NPIs on this enrollment Practice locations: Glenns Ferry, ID; Grand View, ID; Mountain Home, ID |
| O20060103000828 | ID | Part a Provider - Federally Qualified Health Center (FQHC) | 5496656894 | Practice locations: Glenns Ferry, ID |
National Provider Directory
Locations
550 E Jackson St
Mountain Home, ID 83647
Interoperability endpoints
- https://api.platform.athenahealth.com/16522/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | ID | Yes |
Addresses
Primary practice location
486 W 1St Ave
Glenns Ferry, ID 83623-2701
Mailing address
120 Desert Sage Way
Mountain Home, ID 83647-1038
Phone (208) 587-3398
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002550500 | Medicaid | ID | |
| 002550200 | Medicaid | ID |
Other providers in Glenns Ferry, ID
- Anson Call DPT Inc
- Malya Bingham
- County of Elmor Consolidated Class a 192
- Juanita Alicia Garza
- Glenns Ferry Health Center Inc
- Carin Melissa Howard
- Rachelle Alice Jaramillo
- Nichole Koonce
- Ridley'S Family Markets Inc
- Snake River Wellness PLLC
All providers in Glenns Ferry, ID · Federally Qualified Health Center (FQHC) in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.