NPIMap

Organization Active NPI

Gritman Medical Center Inc

Doing business as Gritman Swing Bed Program

  • Skilled Nursing Facility
  • Moscow, ID
National Provider Identifier
1386041119
Registry record updated Oct 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
39 Issued in ID
Legal business name
GRITMAN MEDICAL CENTER INC
Doing business as
Gritman Swing Bed Program
Practice address
700 S Main St
Moscow, ID 83843-3056
Phone
(208) 882-4511
Fax
(208) 883-6580
NPI assigned
Nov 21, 2014
Last updated
Oct 9, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
GRITMAN MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2016

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

Authorized official

Name
Patrick McConnell
Title
Cfo
Phone
(208) 883-2220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 39 ID Primary

Addresses

Primary practice location

700 S Main St
Moscow, ID 83843-3056

Mailing address

700 S Main St
Moscow, ID 83843-3056
Phone (208) 882-4511

Other identifiers 1

IdentifierTypeStateIssuer
1386041119MedicaidID

Other names 1

  • Gritman Swing Bed Program Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150227002006 ID Part A Provider - Critical Access Hospital 8729070164 Practice locations: Moscow, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386041119. Details of each certification follow.

Hospital certification: CCN 13Z327

Legal name
GRITMAN MEDICAL CENTER INC
Doing business as
GRITMAN SWING BED PROGRAM
Organization structure
CorporationNon-profit
Incorporated
Jul 5, 1991 in ID
Enrollment address
700 S Main St
Moscow, ID 83843-3056
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Gritman Home Health6 organizations share this tax ID, including this one
Part of
Gritman Home Health

Other organizations with this tax ID 5

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

Interoperability endpoints

  • FHIR API: https://webprd.ochin.org/prd-fhir/gritman/api/FHIR/R4

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 Aug 14, 2017
W-2 Managing EmployeeCfo Aug 14, 2017
Charles a Jacobson Individual Corporate DirectorBoard of Directors Jan 1, 2013
Stephen T Busch Individual Corporate DirectorVice Chair Jun 1, 2022
Raymond M Paz Individual Corporate Director 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 of Directors Jan 1, 2013
Richard Heimsch Individual Corporate DirectorBoard of Directors Jan 1, 2013
Rula Awwad Rafferty Individual Corporate DirectorBoard of Directors Jan 1, 2013
Aaron L Ranisate Individual Corporate DirectorBoard of Director Sep 4, 2017

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475971200000",
    "number": "1386041119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 S MAIN ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433056",
            "telephone_number": "208-882-4511",
            "fax_number": "208-883-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 S MAIN ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838433056",
            "telephone_number": "208-882-4511",
            "fax_number": "208-883-6580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRITMAN MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRITMAN MEDICAL CENTER",
        "enumeration_date": "2014-11-21",
        "last_updated": "2016-10-09",
        "status": "A",
        "authorized_official_last_name": "MCCONNELL",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "208-883-2220"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ID",
            "license": "39",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386041119",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gritman Swing Bed Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moscow, ID

Sources for this page

Verify at the official NPI Registry.