Good Samaritan Medical Center, LLC
Organization Active NPI General Acute Care Hospital · Lafayette, CO
NPI 1407845035 · NPPES record last updated Apr 28, 2022
Key facts
- NPI
- 1407845035
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 0570 (CO)
- Legal business name
- GOOD SAMARITAN MEDICAL CENTER, LLC
- Practice address
- 200 Exempla Cir
Lafayette, CO 80026-3370 - Phone
- (303) 689-4000
- NPI assigned
- Oct 17, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- SCL HEALTH
Authorized official
- Name
- Hilda Dalfonso
- Title
- VP Finance
- Phone
- (303) 689-5210
Owners & managing parties with NPI records 3
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Member of 2
Member organizations 4
Facilities with the same owner 16
Practitioners 110
-
Robert M Humberstone, M.D.
-
Kelly P Knudson, MD
-
Paul A Stangl, MD
-
Amit Singh Sudan, M.D.
-
Lisa Ahrendt, MD
-
Mana Kouros Amir, MD
-
Kristy Ann Bauman, M.D.
-
Laurie L Carr, M.D.
-
Samay A. Dalal, M.D.
-
Vadim Fayngersh, MD, F.C.C.P.
-
Ora M Fried, MD
-
Rajan K Gupta, MD
-
Christopher Brian Jones, M.D.
-
Laurie Lahr, NP
-
Karng S Log, DO
-
Michael J. Podolak, M.D.
-
Andrew C. Porter, M.D.
Affiliated clinicians 438
-
Brian Joseph Allen, M.D.
-
Jose Amador, FNP-BC
-
Alex N Ashton, PAC
-
Sheryl Lynn Asplund, M.D.
-
Erika Leigh Banka, PA-C
-
Michelle Barron, M.D.
-
Simranjit Singh Bedi, D.O.
-
Samantha Rose Bedinger, PA-C
-
Jason M Bellows, MD
-
Victoria Apollonia Beloy, PA-C
-
Claudia K Benedict, M.D.,F.A.C.C.
-
Judith Berg, NP
-
Richard Bigler, DO
-
Richard F Bindseil, D.O.
-
Jeffrey Allen Bontrager, M.D.
-
Peter Boulos, M.D.
Medicare Care Compare: Hospital
- Listed as
- Good Samaritan Medical Center LLC
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CO
Hospital certification: CCN 060116
- Legal name
- GOOD SAMARITAN MEDICAL CENTER, LLC
- Doing business as
- INTERMOUNTAIN HEALTH GOOD SAMARITAN HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Dec 8, 2004
- Last certification
- Oct 27, 2023
- Beds
- 234
- Ownership / control type
- Private (not for profit)
- Organization structure
- LLC · Non-profit
- Incorporated
- Oct 29, 2002 in CO
- Enrollment address
- 200 Exempla Cir
Lafayette, CO 80026-3370 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Kevin Jenkins |
Corporate Officer |
Mar 3, 2025 | |
| W-2 Managing Employee |
Mar 3, 2025 | ||
| Brooke Bellamy |
Corporate Officer |
May 25, 2025 | |
| W-2 Managing Employee |
May 25, 2025 | ||
| Integrity Health |
5% Or Greater Indirect Ownership Interest | Jul 1, 2024 | |
| Intermountain Front Range, Inc. |
5% Or Greater Direct Ownership Interest | Jul 1, 2024 | 100% |
| Intermountain Health Care, Inc |
Operational/Managerial Control | Apr 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051102001154 | CO | Part B Supplier - Clinic/Group Practice | 7618995275 |
Receives reassigned benefits from 34 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lafayette, CO |
| O20070828000160 | CO | Part a Provider - Hospital | 7618995275 | Practice locations: Lafayette, CO |
National Provider Directory
- Tax ID family
- Exempla Good Samaritan Outpatient Pharmacy
- Part of
- Sisters of Charity of Leavenworth Health System Inc
Locations
300 Exempla Cir
Ste 308
Lafayette, CO 80026
Phone (303) 689-6560
2600 Campus Dr
Lafayette, CO 80026
Phone (303) 689-4000
340 Exempla Cir
Fl 1
Lafayette, CO 80026
Phone (303) 673-1600
340 Exempla Cir
#1
Lafayette, CO 80026
Phone (303) 673-1600
340 Exempla Cir
Fl 2
Lafayette, CO 80026
Phone (303) 689-6580
300 Exempla Cir
Ste 240
Lafayette, CO 80026
Phone (303) 689-6580
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 0570 | CO | Yes |
Addresses
Primary practice location
200 Exempla Cir
Lafayette, CO 80026-3370
Mailing address
200 Exempla Cir
Lafayette, CO 80026-3370
Phone (303) 689-4000
Other names
- Good Samaritan Medical Center
Other providers in Lafayette, CO
- Melinda Teresa Gonzales
- Hector Gonzalez Jr.
- Monica Gonzalez
- Good Samaritan Medical Center LLC
- Good Samaritan Medical Center, LLC
- Gayle M Good
- Ashley Ryan Goodwin
- Derek R Goodyear
- Alyssa Gordon
- Erin E Gordon
All providers in Lafayette, CO · General Acute Care Hospital in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2022. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.