NPIMap

Organization Active NPI

Mountain Family Health Centers

  • Federally Qualified Health Center (FQHC)
  • Rifle, CO
National Provider Identifier
1578862983
Registry record updated Apr 1, 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
Practice address
195 W 14TH Ste C
Rifle, CO 81650-4717
Phone
(970) 945-2840
Fax
(970) 945-2893
NPI assigned
Mar 24, 2011
Last updated
Apr 1, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2021

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

Authorized official

Name
Mr. Ross A Brooks
Title
Ceo
Phone
(970) 945-2840

Specialties & licenses 2

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

Addresses

Primary practice location

195 W 14TH Ste C
Rifle, CO 81650-4717

Mailing address

1905 Blake Ave
Suite 101
Glenwood Springs, CO 81601-4700
Phone (970) 945-2840

Other identifiers 1

IdentifierTypeStateIssuer
05600812MedicaidCO

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
O20110623000309 CO Part A Provider - Federally Qualified Health Center (FQHC) 3173413101 Practice locations: Rifle, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578862983. Details of each certification follow.

Federally qualified health center certification: CCN 061911

Legal name
MOUNTAIN FAMILY HEALTH CENTERS
Doing business as
MOUNTAIN FAMILY HEALTH CENTERS-RIFLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 15, 2011
Last certification
Dec 15, 2011
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 8, 1977 in CO
Enrollment address
195 W 14TH
BLDG C
Rifle, CO 81650-4717

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

Locations

1905 Blake Ave
Ste 101
Glenwood Springs, CO 81601

195 W 14th St
Rifle, CO 81650
Phone (970) 625-5200

Ownership & related parties

All disclosed owners & managing parties 3

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 Corporate OfficerChief Executive Officer Feb 5, 2024 100%
Operational/Managerial ControlChief Executive Officer Feb 5, 2024 100%
Arturo M Fernandez Individual Corporate OfficerCoo Jul 23, 2007 100%
Steven Leazer Individual Corporate OfficerChief Financial Officer May 6, 2024 100%

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 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1300924800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617235200000",
    "number": "1578862983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 BLAKE AVE",
            "address_2": "SUITE 101",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816014700",
            "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": "195 W 14TH STE C",
            "city": "RIFLE",
            "state": "CO",
            "postal_code": "816504717",
            "telephone_number": "970-945-2840",
            "fax_number": "970-945-2893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN FAMILY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-24",
        "last_updated": "2021-04-01",
        "certification_date": "2021-04-01",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "ROSS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-945-2840",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05600812",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rifle, CO

Sources for this page

Verify at the official NPI Registry.