NPIMap

Organization Active NPI

Mountainlands Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Provo, UT
National Provider Identifier
1427437144
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC.
Practice address
299 E 900 S Ste 101
Provo, UT 84606-6107
Phone
(801) 429-2000
NPI assigned
May 27, 2015
Last updated
Mar 27, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Authorized official

Name
Mr. Todd Bailey, MBA, CMPE
Title
Executive Director
Phone
(801) 429-2000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Dentist 122300000X NU
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

299 E 900 S Ste 101
Provo, UT 84606-6107

Mailing address

589 S State St
Provo, UT 84606-5056
Phone (801) 429-2000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160401001839 UT Part A Provider - Federally Qualified Health Center (FQHC) 6305872201 Practice locations: Provo, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427437144. Details of each certification follow.

Federally qualified health center certification: CCN 461853

Legal name
MOUNTAINLANDS COMMUNITY HEALTH CENTER INC
Doing business as
EAST BAY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 11, 2016
Last certification
Mar 11, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
299 E 900 S
Ste 101
Provo, UT 84606-6107

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Mountainlands Community Health Center Inc12 organizations share this tax ID, including this one
Part of
Mountainlands Community Health Center Inc

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Lance Merrell Individual Corporate DirectorBoard of Director Member Jul 20, 2021
Kathryn Asay Individual Corporate DirectorBoard of Director Member Sep 19, 2023
Kimberly Gonzalez Individual Corporate DirectorBoard of Director Member Sep 21, 2021
Molly McCall Individual Corporate OfficerBoard of Director Member May 17, 2022
Bernadine Pacheco Individual Corporate DirectorBoard of Director Member Feb 21, 2023
Gabriel Roca Individual Corporate DirectorBoard of Director Member Sep 20, 2022
Kirk Benge Individual Corporate DirectorBoard of Director Member Mar 16, 2021
Eric Edwards Individual Corporate DirectorBoard of Director Member Jan 19, 2021
Ralph Clegg Individual Corporate DirectorBoard of Director Member Nov 16, 2021
Other Nov 16, 2021
Charles Stubbs Individual Corporate DirectorBoard of Director Member May 19, 2020
Todd Bailey Individual Corporate OfficerExecutive Director Dec 15, 1999
Corporate DirectorExecutive Director Dec 15, 2009
W-2 Managing EmployeeAd; Dec 15, 2009

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1432684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1427437144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 S STATE ST",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846065056",
            "telephone_number": "801-429-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 E 900 S STE 101",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846066107",
            "telephone_number": "801-429-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC.",
        "enumeration_date": "2015-05-27",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-429-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, CMPE"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.