NPIMap

Organization Active NPI

Humboldt General Hospital

Doing business as Humboldt General Hospital Rural Health Clinic

  • Rural Health Clinic/Center
  • Winnemucca, NV
National Provider Identifier
1558633933
Registry record updated Aug 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
7415RHC-1 Issued in NV
Legal business name
HUMBOLDT GENERAL HOSPITAL
Doing business as
Humboldt General Hospital Rural Health Clinic
Practice address
118 E Haskell St
Winnemucca, NV 89445-3247
Phone
(775) 623-5222
Fax
(775) 623-5904
NPI assigned
Feb 1, 2012
Last updated
Aug 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2022

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

Authorized official

Name
Mrs. Robyn Dunckhorst, RN
Title
Administrator
Phone
(775) 623-5222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 7415RHC-1 NV Primary

Addresses

Primary practice location

118 E Haskell St
Winnemucca, NV 89445-3247

Mailing address

118 E Haskell St
Winnemucca, NV 89445-3247
Phone (775) 623-5222

Other names 2

  • Humboldt General Hospital Rural Health Clinic Doing business as
  • Humboldt General Hospital Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd2.ssigroup.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other The SSI Group, LLC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120430000181 CA Part A Provider - Rural Health Clinic 5193709798 Practice locations: Winnemucca, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558633933. Details of each certification follow.

Rural health clinic certification: CCN 293961

Legal name
HUMBOLDT GENERAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 23, 2012
Last certification
Aug 29, 2017
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Jul 1, 1985 in NV
Enrollment address
118 E Haskell St
Winnemucca, NV 89445-3247

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Humboldt General Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/84057439-c01a-4bda-b31b-652cf17a67ad/

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kimberley Anne Plummer Individual W-2 Managing EmployeeCfo Oct 1, 2018
Robyn Ann Dunckhorst Individual Corporate OfficerCeo Oct 20, 2021
W-2 Managing EmployeeCeo Jan 8, 2021

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Humboldt General HospitalWinnemucca, NV, CCN 291308 Hospital Other (100%) Mar 12, 1985
Humboldt General HospitalWinnemucca, NV, CCN 29Z308 Hospital 5% Or Greater Direct Ownership Interest (100%) Mar 24, 2005
Humboldt General HospitalWinnemucca, NV, CCN 295024 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1985

Owned or controlled facilities with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659916800000",
    "number": "1558633933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 E HASKELL ST",
            "city": "WINNEMUCCA",
            "state": "NV",
            "postal_code": "894453247",
            "telephone_number": "775-623-5222",
            "fax_number": "775-623-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 E HASKELL ST",
            "city": "WINNEMUCCA",
            "state": "NV",
            "postal_code": "894453247",
            "telephone_number": "775-623-5222",
            "fax_number": "775-623-5904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMBOLDT GENERAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2022-08-08",
        "certification_date": "2022-08-08",
        "status": "A",
        "authorized_official_last_name": "DUNCKHORST",
        "authorized_official_first_name": "ROBYN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "775-623-5222",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NV",
            "license": "7415RHC-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd2.ssigroup.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "affiliationName": "The SSI Group, LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "118 E Haskell St",
            "city": "Winnemucca",
            "state": "NV",
            "country_code": "US",
            "postal_code": "894453247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Humboldt General Hospital Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Humboldt General Hospital Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Humboldt General Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Winnemucca, NV

Sources for this page

Verify at the official NPI Registry.