NPIMap

Organization Active NPI

Utah Navajo Health System, Incorporated

Doing business as Blanding Family Practice Community Health Center

  • Family Medicine Physician
  • Blanding, UT
National Provider Identifier
1457489486
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
UTAH NAVAJO HEALTH SYSTEM, INCORPORATED
Doing business as
Blanding Family Practice Community Health Center
Practice address
910 S 300 W
Blanding, UT 84511-3910
Phone
(435) 678-3601
Fax
(435) 678-3610
NPI assigned
Mar 1, 2007
Last updated
Feb 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Authorized official

Name
Mr. Michael Jensen
Title
Chief Executive Officer
Phone
(435) 651-3713

Specialties & licenses 1

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

Addresses

Primary practice location

910 S 300 W
Blanding, UT 84511-3910

Mailing address

PO Box 130
Montezuma Creek, UT 84534-0130
Phone (435) 651-3766

Other identifiers 2

IdentifierTypeStateIssuer
1811991151MedicaidUT
1811991151OtherUTNPI # FOR MAIN LOCATION

Other names 1

  • Blanding Family Practice Community Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL www.unhsinc.org

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031121000239 UT Part B Supplier - Clinic/Group Practice 1658275649 Receives reassigned benefits from 66 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monument Valley, UT; Navajo Mountain, UT; Montezuma Creek, UT; Blanding, UT
O20120203000741 UT Part A Provider - Federally Qualified Health Center (FQHC) 1658275649 Practice locations: Blanding, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457489486. Details of each certification follow.

Federally qualified health center certification: CCN 461833

Legal name
UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Doing business as
BLANDING FAMILY PRACTICE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 18, 2012
Last certification
Apr 18, 2012
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2000 in UT
Enrollment address
910 S 300 W
Blanding Family Practice Community Health Center
Blanding, UT 84511-3910

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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
46D0972249Blanding Family Practice910 S 300 W, Blanding, UT 84511AccreditationOct 20, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Lloyd V Jones Individual Corporate OfficerChief Medical Officer Aug 23, 2011 15%
Michael S Jensen Individual Corporate OfficerChief Executive Officer Aug 23, 2011 100%
Utah Navajo Health System Incorporated Organization, Montezuma Creek, UT Non-profit Operational/Managerial Control Aug 23, 2011 100%
Tiffany Mitchell Individual W-2 Managing EmployeeAccounts Receivable Manager May 1, 2020 10%
Jamie Harvey Individual Corporate DirectorBoard Member Aug 23, 2011
Gloria Begaye Individual Corporate DirectorBoard Member Aug 23, 2011
Harriett Lansing Individual Corporate DirectorBoard Member Aug 23, 2011
Nicholas R Fox Individual Corporate DirectorNursing Director Aug 23, 2011 60%
Cassandra Beletso Individual Corporate DirectorBoard Member Aug 23, 2011
Wilfred R Jones Individual Corporate DirectorBoard Member Aug 23, 2011
Alva B Clarke Individual Corporate OfficerChief Operation Officer May 1, 2016 100%
Melinda Farley Individual Corporate DirectorBoard Member Aug 23, 2011
Edward Tapaha Individual Corporate DirectorBoard Member Aug 23, 2011
Kenneth Miles Individual Corporate DirectorBoard Member Aug 23, 2011
Andrew Evans Individual Corporate OfficerChief Financial Officer Feb 14, 2019 50%

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Monument Valley Health Center-SatelliteMonument Valley, UT, CCN 461835 Federally qualified health center Operational/Managerial Control (100%) Aug 23, 2018

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 117

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 117

NPI Registry JSON

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1457489486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 130",
            "city": "MONTEZUMA CREEK",
            "state": "UT",
            "postal_code": "845340130",
            "telephone_number": "435-651-3766",
            "fax_number": "435-651-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 S 300 W",
            "city": "BLANDING",
            "state": "UT",
            "postal_code": "845113910",
            "telephone_number": "435-678-3601",
            "fax_number": "435-678-3610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH NAVAJO HEALTH SYSTEM, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A",
        "authorized_official_last_name": "JENSEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "435-651-3713",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811991151",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI # FOR MAIN LOCATION",
            "identifier": "1811991151",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.unhsinc.org",
            "affiliation": "N",
            "address_1": "910 S 300 W",
            "city": "Blanding",
            "state": "UT",
            "country_code": "US",
            "postal_code": "845113910",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Blanding Family Practice Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blanding Family Practice Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blanding, UT

Sources for this page

Verify at the official NPI Registry.