Banner Churchill Community Hospital
Organization Active NPI Rural Health Clinic/Center · Fernley, NV
NPI 1548780554 · NPPES record last updated Mar 6, 2025
Key facts
- NPI
- 1548780554
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- Yes
- Parent organization (as reported)
- BANNER HEALTH
Authorized official
- Name
- Robert Carnahan
- Title
- Ceo
- Phone
- (602) 747-4000
Owners & managing parties with NPI records 12
-
Marjorie Bessel, MD
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 5
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 59
Practitioners 23
-
Wade E Anderson, MD
-
Mark A. Demar, M.D.
-
Ricardo A Garcia, M.D.
-
Misty Kasky, DO
-
Ryan J Kasky, DO
-
Dong-Young Kim, FNP
-
Dillon R Lambert, APRN
-
Sharon Lynn Maxwell, PA-C, MPAS
-
Thomas Vance McCormick, M.D.
-
Britany Ann Ortega, MSN, RN, FNP-C
-
Christa Robinson, PA-C
-
Darin Matthew Rolfe, M.D.
-
Daniel Matthew Stasik, PA-C
-
Jay Boughanem, MD
-
Ralph Narinedhat, M.D.
-
James J Zubernis, DO
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 29D0938502 | Banner Health Center Fernley | Provider-performed microscopy | Jul 14, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
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
- Other · Non-profit
- Enrollment address
- 1260 Nevada Pacific Blvd
Fernley, NV 89408-9871 - Related CCNs
- 291313
All disclosed owners & managing parties 24
| Name | Role | Since | Share |
|---|---|---|---|
| Julie Ann Alvarado-Dubek |
Corporate Officer |
Feb 1, 2022 | |
| Marjorie J Bessel |
Corporate Officer |
Jan 1, 2018 | |
| Jean Lance |
Corporate Officer |
Jun 30, 2022 | |
| Robert H Carnahan |
Corporate Officer |
May 1, 2017 | |
| W-2 Managing Employee |
May 1, 2017 | ||
| Operational/Managerial Control |
May 1, 2017 | ||
| Staci Dickerson |
Corporate Officer |
Jul 17, 2023 | |
| W-2 Managing Employee |
Jul 17, 2023 | ||
| Carole Faig |
Corporate Director |
Mar 1, 2026 | |
| Paris Labruzzo |
Corporate Director |
Feb 1, 2026 | |
| W-2 Managing Employee | Feb 1, 2026 | ||
| Dean M Harrison |
Corporate Director |
Sep 1, 2023 | |
| Anne Mariucci |
Corporate Director |
Mar 1, 2015 | |
| Sujata Gosalia |
Corporate Director |
Sep 1, 2018 | |
| Brenda a Schaefer |
Corporate Officer |
Mar 6, 2014 | |
| Quentin P Smith |
Corporate Director |
Sep 11, 1999 | |
| Vicki Keiser |
Corporate Director |
Jun 1, 2017 | |
| Holly Gregory |
Corporate Director |
Jul 24, 2020 | |
| W-2 Managing Employee | Jul 24, 2020 | ||
| Sara Ward |
Corporate Director |
Sep 1, 2023 | |
| Michael L Butler |
Corporate Director |
Sep 1, 2025 | |
| Mary Schubert |
Corporate Officer |
Jan 1, 2024 | |
| Amy Perry |
Corporate Officer |
Nov 1, 2021 | |
| Rick Myers |
Corporate Director |
Sep 1, 2023 | |
| John F Koster |
Corporate Director |
Dec 11, 2015 | |
| Mark Wallace |
Corporate Director |
Sep 1, 2021 | |
| Christopher H Volk |
Corporate Director |
Sep 1, 1999 | |
| Michael Garnreiter |
Corporate Director |
Aug 1, 2012 | |
| Banner Health |
5% Or Greater Direct Ownership Interest | Jan 1, 2018 | 100% |
| Operational/Managerial Control | Jan 1, 2018 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171011001557 | NV | Part a Provider - Rural Health Clinic | 9638080500 | Practice locations: Fernley, NV |
National Provider Directory
- Tax ID family
- Banner Churchill Comm Hosp
- Part of
- M E Lee MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- Banner Health Center Fernley
Other providers in Fernley, NV
- Atlas Counseling Center, LLC
- Amanda Beth Backlund
- Laura Leigh Bage
- Brittany Bailey-Duran
- Harrie F Baker
- Banner Churchill Community Hospital
- Banner Health Physicians West LLC
- John H. Barona
- Kim Patrick Baumgardner
- Behavior Built LLC
All providers in Fernley, NV · Rural Health Clinic/Center in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.