NPIMap

Organization Active NPI

Mountain Family Health Centers

Doing business as Mountain Family Health Centers Avon School Based Health Center

  • Federally Qualified Health Center (FQHC)
  • Avon, CO
National Provider Identifier
1548613409
Registry record updated Feb 8, 2021
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
Doing business as
Mountain Family Health Centers Avon School Based Health Center
Practice address
0850 West Beaver Creek Blvd
Avon, CO 81620
Phone
(970) 945-2840
Fax
(970) 569-3450
NPI assigned
Jul 15, 2016
Last updated
Feb 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Authorized official

Name
Ross A. Brooks
Title
Chief Executive Officer
Phone
(970) 945-2840

Specialties & licenses 2

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

Addresses

Primary practice location

0850 West Beaver Creek Blvd
Avon, CO 81620

Mailing address

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

Other names 1

  • Mountain Family Health Centers Avon School Based Health Center Doing business as

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
This NPI is an additional NPI on the enrollment
Practice locations: Gypsum, CO; Rifle, CO; Glenwood Springs, CO; Basalt, CO; Avon, CO
O20161216001394 CO Part A Provider - Federally Qualified Health Center (FQHC) 3173413101 Practice locations: Avon, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548613409. Details of each certification follow.

Federally qualified health center certification: CCN 061975

Legal name
MOUNTAIN FAMILY HEALTH CENTERS
Doing business as
MOUNTAIN FAMILY HEALTH CENTERS AVON SCHOOL BASED HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 2016
Last certification
Dec 1, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 8, 1977 in CO
Enrollment address
0850 West Beaver Creek Blvd
Avon, CO 81620

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
Tax ID family
Mountain Fmly HLTH Centers14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

2700 Gilstrap Ct
Ste 230
Glenwood Springs, CO 81601

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Dustin Moyer Individual Operational/Managerial ControlChief Executive Officer Feb 5, 2024 100%
Patricia Kramer Individual Corporate DirectorBoard of Directors Treasurer Sep 27, 2022
Arturo M Fernandez Individual Corporate Officer Nov 18, 2016
W-2 Managing Employee Nov 18, 2016
Sydney Schalit Individual Corporate DirectorBoard of Director Chair Sep 27, 2022
Steven Leazer Individual Corporate OfficerChief Financial Officer May 6, 2024

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 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1548613409",
    "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": "0850 WEST BEAVER CREEK BLVD",
            "city": "AVON",
            "state": "CO",
            "postal_code": "81620",
            "telephone_number": "970-945-2840",
            "fax_number": "970-569-3450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN FAMILY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-15",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "970-945-2840"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Family Health Centers Avon School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain Family Health Centers Avon School Based Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avon, CO

Sources for this page

Verify at the official NPI Registry.