NPIMap

Organization Active NPI

Carbon Medical Service Association, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Sunnyside, UT
National Provider Identifier
1497717821
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
Practice address
331 Highway 123
Sunnyside, UT 84539
Phone
(435) 888-4411
Fax
(435) 888-2270
NPI assigned
Apr 3, 2006
Last updated
Jun 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Authorized official

Name
Carolyn Sue Abeyta
Title
Executive Director
Phone
(435) 888-4411

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X UT Primary
Multi-Specialty Clinic/Center 261QM1300X UT

Addresses

Primary practice location

331 Highway 123
Sunnyside, UT 84539

Mailing address

305 Center St.
P. O. Box 930
East Carbon, UT 84520-0930
Phone (435) 888-4411

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050606001229 UT Part B Supplier - Clinic/Group Practice 4183535115 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
Practice locations: Helper, UT; Sunnyside, UT; Price, UT
O20061207000258 UT Part A Provider - Federally Qualified Health Center (FQHC) 4183535115 Practice locations: Sunnyside, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497717821. Details of each certification follow.

Federally qualified health center certification: CCN 461801

Legal name
CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 17, 1992
Last certification
Apr 17, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 5, 1952 in UT
Enrollment address
331 Highway 123
Sunnyside, UT 84539-7702

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

Other NPIs with the same Medicare PAC ID 2

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.

National Provider Directory

National Provider Directory

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
Crestina Trujillo Individual Corporate Officer Jan 21, 2013
Jeff Braby Individual Corporate DirectorBoard Member Feb 27, 2019
Jacqueline Crary Individual Corporate Director Feb 26, 2025
David Palacios Individual Corporate Director Feb 26, 2025
Jack Ori Individual Corporate DirectorBoard Member Oct 30, 2013
Don Logston Individual Corporate DirectorBoard Member Apr 30, 2013
Alyssa Wilberg Individual Corporate DirectorBoard Member Jul 13, 2013
Michael Oshea Individual Corporate DirectorBoard Member Jan 27, 2021
Lisa Kay Clark Individual Corporate OfficerCeo Jun 28, 2024
W-2 Managing Employee Jun 28, 2024
Kristy Candelaria Individual Corporate Director Sep 27, 2023
Ramona Holt Individual Corporate DirectorBoard Member Apr 11, 2013
Becky Colombo Individual Corporate Director Sep 27, 2023
Kimalee Allred Individual Corporate DirectorBoard Member Jun 29, 2017

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561075200000",
    "number": "1497717821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 CENTER ST.",
            "address_2": "P. O. BOX 930",
            "city": "EAST CARBON",
            "state": "UT",
            "postal_code": "845200930",
            "telephone_number": "435-888-4411",
            "fax_number": "435-888-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 HIGHWAY 123",
            "city": "SUNNYSIDE",
            "state": "UT",
            "postal_code": "84539",
            "telephone_number": "435-888-4411",
            "fax_number": "435-888-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2019-06-21",
        "status": "A",
        "authorized_official_last_name": "ABEYTA",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "435-888-4411"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "UT",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "UT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunnyside, UT

Sources for this page

Verify at the official NPI Registry.