NPIMap

Organization Active NPI

Lost Rivers Medical Center

Doing business as Arco Clinic

  • Family Medicine Physician
  • Arco, ID
National Provider Identifier
1427062181
Registry record updated May 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LOST RIVERS MEDICAL CENTER
Doing business as
Arco Clinic
Practice address
551 Highland Dr
Arco, ID 83213-5003
Phone
(208) 527-8206
Fax
(208) 527-3616
NPI assigned
Jul 28, 2006
Last updated
May 1, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2017

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

Authorized official

Name
Mr. Brad Huerta
Title
Ceo
Phone
(208) 527-8206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

551 Highland Dr
Arco, ID 83213-5003

Mailing address

PO Box 815
Arco, ID 83213-0815
Phone (208) 527-8206

Other names 1

  • ARCO CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030513000038 ID Part A Provider - Rural Health Clinic 7810807427 Practice locations: Arco, ID
O20040612000135 ID Part B Supplier - Clinic/Group Practice 7810807427 Receives reassigned benefits from 21 practitioners
Practice locations: Arco, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427062181. Details of each certification follow.

Rural health clinic certification: CCN 133981

Legal name
LOST RIVERS MEDICAL CENTER
Doing business as
ARCO CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 27, 1992
Last certification
Apr 27, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
551 Highland Dr
Arco, ID 83213-5003
Related CCNs
131324

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).

National Provider Directory

National Provider Directory
Tax ID family
Lost Rivers Hospital7 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 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bradley Huerta Individual Corporate OfficerCeo Apr 15, 2013 100%
W-2 Managing EmployeeCeo Apr 15, 2013 100%
Toni Spencer Individual Corporate DirectorBoard Member Mar 1, 2013 100%
Lost Rivers Medical Center Organization, Arco, ID Operational/Managerial Control Apr 24, 2008

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lost Rivers Medical CenterArco, ID, CCN 131324 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Dec 1, 1975
Lost Rivers SwingbedArco, ID, CCN 13Z324 Hospital 5% Or Greater Direct Ownership Interest Jun 25, 2010
Mackay ClinicMackay, ID, CCN 133990 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 24, 2014

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1427062181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 815",
            "city": "ARCO",
            "state": "ID",
            "postal_code": "832130815",
            "telephone_number": "208-527-8206",
            "fax_number": "208-527-3616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 HIGHLAND DR",
            "city": "ARCO",
            "state": "ID",
            "postal_code": "832135003",
            "telephone_number": "208-527-8206",
            "fax_number": "208-527-3616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOST RIVERS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "HUERTA",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-527-8206",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ARCO CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arco, ID

Sources for this page

Verify at the official NPI Registry.