NPIMap

Organization Active NPI

St. Vincent General Hospital District

  • Primary Care Clinic/Center
  • Leadville, CO
National Provider Identifier
1497710958
Registry record updated Aug 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ST. VINCENT GENERAL HOSPITAL DISTRICT
Practice address
822 W 4TH Street
Leadville, CO 80461
Phone
(719) 486-0230
Fax
(719) 486-1077
NPI assigned
Apr 19, 2006
Last updated
Aug 27, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2024

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

Authorized official

Name
Andrew Dreesen
Title
Authorized Official
Phone
(719) 486-7161

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinic/Center 261Q00000X
Primary Care Clinic/Center 261QP2300X Primary
Critical Access Hospital 282NC0060X 0185 CO
Critical Access Hospital 282NC0060X 010908 CO
Critical Access Hospital 282NC0060X

Addresses

Primary practice location

822 W 4TH Street
Leadville, CO 80461

Mailing address

822 W 4TH Street
Leadville, CO 80461
Phone (719) 486-0230

Other practice location 1

816 W 4th St
Leadville, CO 80461-3861
Phone (719) 486-0230

Other practice location 2

735 US Highway 24
Leadville, CO 80461-3978
Phone (719) 486-0230

Other identifiers 1

IdentifierTypeStateIssuer
04003828MedicaidCO

Other names 1

  • St. Vincent General Hospital District Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316001421 CO Part B Supplier - Clinic/Group Practice 4587574884 Receives reassigned benefits from 54 practitioners
3 other NPIs on this enrollment
Practice locations: Leadville, CO

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 3

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

National Provider Directory

National Provider Directory

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
St. Vincent General Hospital DistrictLeadville, CO, CCN 061319 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 25, 2013
Nov 22, 2010
St. Vincent General Hospital DistrictLeadville, CO, CCN 06Z319 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jun 25, 2013
Nov 22, 2010
St.Vincent Family Health Center and Urgent CareLeadville, CO, CCN 068529 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Sep 10, 2020
Sep 10, 2020

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724716800000",
    "number": "1497710958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "822 W 4TH STREET",
            "city": "LEADVILLE",
            "state": "CO",
            "postal_code": "80461",
            "telephone_number": "719-486-0230",
            "fax_number": "719-486-1077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 W 4TH STREET",
            "city": "LEADVILLE",
            "state": "CO",
            "postal_code": "80461",
            "telephone_number": "719-486-0230",
            "fax_number": "719-486-1077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "816 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Leadville",
            "state": "CO",
            "postal_code": "804613861",
            "country_code": "US",
            "telephone_number": "719-486-0230",
            "fax_number": "719-486-1077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "735 US Highway 24",
            "address_purpose": "LOCATION",
            "city": "Leadville",
            "state": "CO",
            "postal_code": "804613978",
            "country_code": "US",
            "telephone_number": "719-486-0230",
            "fax_number": "719-486-1077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. VINCENT GENERAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2024-08-27",
        "certification_date": "2024-08-27",
        "status": "A",
        "authorized_official_last_name": "DREESEN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "719-486-7161"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "CO",
            "license": "0185",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "CO",
            "license": "010908",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04003828",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Vincent General Hospital District",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Leadville, CO

Sources for this page

Verify at the official NPI Registry.