NPIMap

Organization Active NPI

Banner Churchill Community Hospital

  • Rural Health Clinic/Center
  • Fernley, NV
National Provider Identifier
1548780554
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BANNER CHURCHILL COMMUNITY HOSPITAL
Practice address
1260 Nevada Pacific Blvd
Fernley, NV 89408-9871
Phone
(775) 575-7171
Fax
(775) 575-7227
NPI assigned
Jun 21, 2017
Last updated
Mar 6, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
BANNER HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

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

Authorized official

Name
Robert Carnahan
Title
Ceo
Phone
(602) 747-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1260 Nevada Pacific Blvd
Fernley, NV 89408-9871

Mailing address

2901 N Central Ave Ste 160
Phoenix, AZ 85012-2702

Other names 1

  • Banner Health Center Fernley Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171011001557 NV Part A Provider - Rural Health Clinic 9638080500 Practice locations: Fernley, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548780554. Details of each certification follow.

Rural health clinic certification: CCN 293990

Legal name
BANNER CHURCHILL COMMUNITY HOSPITAL
Doing business as
BANNER HEALTH CENTER FERNLEY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 5, 2018
Last certification
Jun 16, 2021
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
1260 Nevada Pacific Blvd
Fernley, NV 89408-9871
Related CCNs
291313

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).

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
29D0938502Banner Health Center Fernley1260 Nevada Pacific Blvd, Fernley, NV 89408Provider-performed microscopyJul 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Churchill Community Hos6 organizations share this tax ID, including this one
Part of
Custer Comm Hosp Rad

Other organizations with this tax ID 5

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

  • Banner Health

    dba Banner Hospice of Northern Colorado

    • Community Based Hospice Care Agency
    • Greeley, CO
    • NPI 1407409964

    Member Of

    NPD member

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Julie Ann Alvarado-Dubek Individual Corporate OfficerOfficer Feb 1, 2022
Marjorie J Bessel Individual Corporate OfficerOfficer Jan 1, 2018
Jean Lance Individual Corporate OfficerChief Legal Officer Jun 30, 2022
Robert H Carnahan Individual Corporate OfficerCeo May 1, 2017
W-2 Managing EmployeeCeo May 1, 2017
Operational/Managerial ControlCeo May 1, 2017
Staci Dickerson Individual Corporate OfficerCfo Jul 17, 2023
W-2 Managing EmployeeCfo Jul 17, 2023
Carole Faig Individual Corporate DirectorBoard Member Mar 1, 2026
Paris Labruzzo Individual Corporate DirectorSr Director Feb 1, 2026
W-2 Managing Employee Feb 1, 2026
Dean M Harrison Individual Corporate DirectorBoard Member Sep 1, 2023
Anne Mariucci Individual Corporate DirectorBoard Member Mar 1, 2015
Sujata Gosalia Individual Corporate DirectorDirector Sep 1, 2018
Brenda a Schaefer Individual Corporate OfficerTreasurer Mar 6, 2014
Quentin P Smith Individual Corporate DirectorBoard Member Sep 11, 1999
Vicki Keiser Individual Corporate DirectorDirector Jun 1, 2017
Holly Gregory Individual Corporate DirectorSr Manager Jul 24, 2020
W-2 Managing Employee Jul 24, 2020
Sara Ward Individual Corporate DirectorBoard Member Sep 1, 2023
Michael L Butler Individual Corporate DirectorBoard Member Sep 1, 2025
Mary Schubert Individual Corporate OfficerAssistant Secretary Jan 1, 2024
Amy Perry Individual Corporate OfficerPresident/Ceo Nov 1, 2021
Rick Myers Individual Corporate DirectorBoard Member Sep 1, 2023
John F Koster Individual Corporate DirectorBoard Member Dec 11, 2015
Mark Wallace Individual Corporate DirectorDirector Sep 1, 2021
Christopher H Volk Individual Corporate DirectorBoard Member Sep 1, 1999
Michael Garnreiter Individual Corporate DirectorBoard Member Aug 1, 2012
Banner Health Organization, Phoenix, AZ Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
Operational/Managerial Control Jan 1, 2018 100%

Owners & managing parties with NPI records 12

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

  • Banner Health

    dba Banner Casa Grande Medical Center

    • General Acute Care Hospital
    • Casa Grande, AZ
    • NPI 1003232976

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health

    dba Banner Payson Medical Center

    • Critical Access Hospital
    • Payson, AZ
    • NPI 1063923340

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health

    dba Banner Payson Medical Center - Banner Health Clinic Payson

    • Rural Health Clinic/Center
    • Payson, AZ
    • NPI 1073223012

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health
    • Multi-Specialty Clinic/Center
    • Susanville, CA
    • NPI 1205267549

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health

    dba Banner Payson Medical Center - Banner Health Clinic Pine

    • Rural Health Clinic/Center
    • Pine, AZ
    • NPI 1245940287

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health

    dba Banner Hospice of Northern Colorado

    • Community Based Hospice Care Agency
    • Greeley, CO
    • NPI 1407409964

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health
    • Radiology Clinic/Center
    • Susanville, CA
    • NPI 1427740570

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health
    • Durable Medical Equipment & Medical Supplies
    • Casper, WY
    • NPI 1528846912

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health

    dba Banner Fort Collins Medical Center

    • General Acute Care Hospital
    • Fort Collins, CO
    • NPI 1659787554

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health

    dba Banner Payson Medical Center

    • Medicare Defined Swing Bed Hospital Unit
    • Payson, AZ
    • NPI 1861077414

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Banner Health

    dba Banner Ocotillo Medical Center

    • General Acute Care Hospital
    • Chandler, AZ
    • NPI 1972139004

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Marjorie Bessel, MD
    • Internal Medicine Physician
    • Gilbert, AZ
    • NPI 1710002068

    Corporate Officer

    CMS ownership

Facilities with the same owner 59

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 59

NPI Registry JSON

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

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741219200000",
    "number": "1548780554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2901 N CENTRAL AVE STE 160",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 NEVADA PACIFIC BLVD",
            "city": "FERNLEY",
            "state": "NV",
            "postal_code": "894089871",
            "telephone_number": "775-575-7171",
            "fax_number": "775-575-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BANNER CHURCHILL COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BANNER HEALTH",
        "enumeration_date": "2017-06-21",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A",
        "authorized_official_last_name": "CARNAHAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-747-4000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Banner Health Center Fernley",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fernley, NV

Sources for this page

Verify at the official NPI Registry.