NPIMap

Organization Active NPI

Mountain Family Health Centers

  • Federally Qualified Health Center (FQHC)
  • Glenwood Springs, CO
National Provider Identifier
1477552388
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAIN FAMILY HEALTH CENTERS
Practice address
1905 Blake Ave
Suite 101
Glenwood Springs, CO 81601-4288
Phone
(970) 945-2840
Fax
(970) 945-2893
NPI assigned
Jul 21, 2005
Last updated
Jun 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Authorized official

Name
Mr. Dustin Moyer
Title
Ceo
Phone
(970) 945-2840

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1905 Blake Ave
Suite 101
Glenwood Springs, CO 81601-4288

Mailing address

2700 Gilstrap CT Ste 230
Glenwood Springs, CO 81601-8735
Phone (970) 945-2840

Other identifiers 1

IdentifierTypeStateIssuer
05600812MedicaidCO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040316000175 CO Part B Supplier - Clinic/Group Practice 3173413101 Receives reassigned benefits from 32 practitioners
9 other NPIs on this enrollment
Practice locations: Gypsum, CO; Rifle, CO; Glenwood Springs, CO; Basalt, CO; Avon, CO
O20070827000778 CO Part A Provider - Federally Qualified Health Center (FQHC) 3173413101 1 other NPI on this enrollment
Practice locations: Glenwood Springs, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477552388. Details of each certification follow.

Federally qualified health center certification: CCN 061872

Legal name
MOUNTAIN FAMILY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 28, 2002
Last certification
Jun 28, 2002
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jul 7, 1978 in CO
Enrollment address
1905 Blake Ave
Ste 101
Glenwood Springs, CO 81601-4206
Related CCNs
061837

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

195 W 14th St
Ste C
Rifle, CO 81650

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
Chris Lindley Individual Operational/Managerial ControlBoard of Directors Member Jan 1, 2022
Elena Broaddus Individual Operational/Managerial ControlBoard of Directors Member Sep 1, 2023
Paul Corcoran Individual Operational/Managerial ControlBoard of Directors Member Oct 1, 2023
Dustin Moyer Individual Corporate OfficerChief Executive Officer Feb 5, 2024
Hannah Berman Individual Operational/Managerial ControlBoard of Directors Member Nov 1, 2023
Patricia Kramer Individual Corporate DirectorBoard of Directors Treasurer Feb 1, 2017 100%
Kendall Reiley Individual Operational/Managerial ControlBoard of Directors Member Nov 1, 2023
Arturo M Fernandez Individual Corporate OfficerChief Operations Officer Jul 23, 2007
W-2 Managing EmployeeChief Operations Officer Jul 23, 2007
Sydney Schalit Individual Corporate DirectorBoard of Directors Chair Oct 1, 2020 100%
Monica Perez Rhodes Individual Operational/Managerial ControlBoard of Directors Member Mar 1, 2023
Kelly Medina Individual Operational/Managerial ControlBoard of Directors Member Jan 1, 2025
Melina Valsecia Individual Operational/Managerial ControlBoard of Directors Member Apr 1, 2022
Missael Urtiaga Gutierrez Individual Operational/Managerial ControlBoard of Directors Member Jun 1, 2023
Steven Leazer Individual Corporate OfficerChief Financial Officer May 6, 2024
Elaine Eva Huber Individual Corporate DirectorBoard of Directors Vice Chair Apr 1, 2022 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mountain Family Health CentersAvon, CO, CCN 061046 Federally qualified health center Operational/Managerial Control (100%) Jan 3, 2023

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1477552388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 GILSTRAP CT STE 230",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816018735",
            "telephone_number": "970-945-2840",
            "fax_number": "970-945-2893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 BLAKE AVE",
            "address_2": "SUITE 101",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816014288",
            "telephone_number": "970-945-2840",
            "fax_number": "970-945-2893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN FAMILY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "MOYER",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-945-2840",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05600812",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenwood Springs, CO

Sources for this page

Verify at the official NPI Registry.