NPIMap

Organization Active NPI

Trinidad Area Health Association

Doing business as Mt. San Rafael Hospital Clinic

  • Family Medicine Physician
  • Trinidad, CO
National Provider Identifier
1467400309
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TRINIDAD AREA HEALTH ASSOCIATION
Doing business as
Mt. San Rafael Hospital Clinic
Practice address
400 Benedicta Ave
Trinidad, CO 81082-2099
Phone
(719) 845-3168
Fax
(719) 845-4243
NPI assigned
May 4, 2006
Last updated
Apr 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Authorized official

Name
Kathy Topping
Title
PFS Directore
Phone
(719) 845-3168

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Family Medicine Physician 207Q00000X CO Primary
Internal Medicine Physician 207R00000X CO
Pediatrics Physician 208000000X CO

Addresses

Primary practice location

400 Benedicta Ave
Trinidad, CO 81082-2099

Mailing address

410 Benedicta Avenue
Trinidad, CO 81082
Phone (719) 846-9213

Other names 1

  • Mt. San Rafael Hospital Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031111000178 CO Part B Supplier - Clinic/Group Practice 2769394055 Receives reassigned benefits from 72 practitioners
2 other NPIs on this enrollment
Practice locations: Trinidad, CO
O20060227000475 CO Part A Provider - Rural Health Clinic 2769394055 Practice locations: Trinidad, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467400309. Details of each certification follow.

Rural health clinic certification: CCN 063404

Legal name
TRINIDAD AREA HEALTH ASSOCIATION
Doing business as
MT SAN RAFAEL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 2, 2004
Last certification
Mar 6, 2024
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Jul 25, 1969 in CO
Enrollment address
400 Benedicta Ave
Trinidad, CO 81082-2099
Related CCNs
061321

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 1

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
06D1047432Mt San Rafael Hospital Clinic400 Benedicta Ave, Trinidad, CO 81082Provider-performed microscopyNov 3, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kim Lucero Individual Corporate Director Jul 8, 2022
W-2 Managing Employee Jul 8, 2022
Trinidad Area Health Association Organization, Trinidad, CO 5% Or Greater Direct Ownership Interest Nov 1, 2005
Operational/Managerial Control Nov 1, 2005

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mt. San Rafael HospitalTrinidad, CO, CCN 061321 Hospital Operational/Managerial Control (100%) Jul 10, 1969
Mt. San Rafael HospitalTrinidad, CO, CCN 06Z321 Hospital Operational/Managerial Control (100%) Jul 10, 1969

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 161

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 161

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1467400309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 BENEDICTA AVENUE",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "81082",
            "telephone_number": "719-846-9213",
            "fax_number": "719-845-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 BENEDICTA AVE",
            "city": "TRINIDAD",
            "state": "CO",
            "postal_code": "810822099",
            "telephone_number": "719-845-3168",
            "fax_number": "719-845-4243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINIDAD AREA HEALTH ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "TOPPING",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "PFS DIRECTORE",
        "authorized_official_telephone_number": "719-845-3168"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mt. San Rafael Hospital Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Trinidad, CO

Sources for this page

Verify at the official NPI Registry.