NPIMap

Organization Active NPI

Mountainlands Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Payson, UT
National Provider Identifier
1437364882
Registry record updated Oct 2, 2026
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
285 N 1250 E # 103
Payson, UT 84651-5794
Phone
(801) 429-2000
Fax
(801) 429-2001
NPI assigned
May 11, 2007
Last updated
Oct 2, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNTAINLANDS COMMUNITY HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2026

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

Authorized official

Name
Todd Bailey
Title
Chief Financial Officer
Phone
(801) 374-9660

Specialties & licenses 2

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

Addresses

Primary practice location

285 N 1250 E # 103
Payson, UT 84651-5794

Mailing address

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

Other names 1

  • Payson Family Health Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050712000914 UT Part B Supplier - Clinic/Group Practice 6305872201 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Provo, UT; Vernal, UT; Payson, UT
O20111021000476 UT Part A Provider - Federally Qualified Health Center (FQHC) 6305872201 Practice locations: Payson, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437364882. Details of each certification follow.

Federally qualified health center certification: CCN 461832

Legal name
MOUNTAINLANDS COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 22, 2011
Last certification
Dec 22, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 19, 2005 in UT
Enrollment address
285 N 1250 E
# 103
Payson, UT 84651-5794

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2109434Mountainlands Family Health Center - Payson285 N 1250 E, Suite 103, Payson, UT 84651Certificate of waiverFeb 24, 2028

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.

Locations

285 N 1250 E
Ste 103
Payson, UT 84651
Phone (801) 429-2000

Ownership & related parties

All disclosed owners & managing parties 13

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 Director Jul 20, 2021
Logan Gillette Individual Corporate Director Aug 17, 2021
Kimberly Gonzalez Individual Corporate Director Sep 21, 2021
Adriana Chaua Individual Corporate Director Jun 19, 2018
Daniel Tventen Individual Corporate Director Jan 4, 2021
Monica Villarreal Individual Corporate Director May 19, 2020
Kirk Benge Individual Corporate Director Mar 16, 2021
Eric Edwards Individual Corporate Director Jan 19, 2021
Ralph Clegg Individual Corporate Director Nov 16, 2021
Charles Stubbs Individual Corporate Officer May 19, 2020
Eric Johnson Individual W-2 Managing EmployeeFinancial Director Jan 1, 2010
Todd Bailey Individual Corporate Officer Dec 1, 2009
Bruce B Grover Individual W-2 Managing EmployeeMedical Director Jul 17, 1995

Owners & managing parties with NPI records 1

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

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 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790899200000",
    "number": "1437364882",
    "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",
            "fax_number": "801-429-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 N 1250 E # 103",
            "city": "PAYSON",
            "state": "UT",
            "postal_code": "846515794",
            "telephone_number": "801-429-2000",
            "fax_number": "801-429-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC",
        "enumeration_date": "2007-05-11",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "801-374-9660"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Payson Family Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Payson Family Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Payson, UT

Sources for this page

Verify at the official NPI Registry.