Health West, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Evanston, WY
NPI 1619683547 · NPPES record last updated Jan 24, 2023
Key facts
- NPI
- 1619683547
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- HEALTH WEST, INC.
- Practice address
- 75 Yellow Creek Rd Ste 102
Evanston, WY 82930-5205 - Phone
- (307) 789-8290
- NPI assigned
- Jan 24, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- HEALTH WEST, INC.
Authorized official
- Name
- Amelia Murphy
- Title
- Medical Staff Coordinator
- Phone
- (208) 232-7862
Owners & managing parties with NPI records 1
-
Mark Horrocks, M.D.
Other NPIs on the same Medicare enrollment 1
Practitioners 12
-
Phillip Edward Archibald, LCSW
-
Jaden Rochelle Bingham, APRN, FNP-BC
-
Brianne Emory Stringer, APRN, FNP-BC
-
Stephen M Walker, PCSW
-
Jennifer Whitten, LCSW
-
Benjamin R Kadas, APN
-
Jon Daniel Malan, DO
-
Kathy Bella, ARNP FNP-C
-
Ashlee J Ledgess, DNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WY
Federally qualified health center certification: CCN 531000
- Legal name
- HEALTH WEST INC
- Doing business as
- HEALTH WEST EVANSTON
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 8, 2024
- Last certification
- Mar 8, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1975 in ID
- Enrollment address
- 75 Yellow Creek Rd
Ste 102
Evanston, WY 82930-5205
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Nichole Wortham |
Corporate Officer | Jun 11, 2020 | |
| Alyson Later |
W-2 Managing Employee | May 26, 2022 | |
| Carol Gilbert |
Corporate Officer | Nov 30, 2023 | |
| Amy Wuest |
Corporate Director | Sep 14, 2022 | |
| Doug Mathis |
Corporate Director | Jul 27, 2015 | |
| Iris Buder |
Corporate Director | Nov 23, 2015 | |
| Mark T Horrocks |
Corporate Officer | Oct 30, 2002 | |
| Larry Burden |
Corporate Director | Aug 24, 2021 | |
| Irene Barrett |
Corporate Director | Apr 27, 2021 | |
| Paul Morgan |
Corporate Officer | Jul 10, 2017 | |
| Charles Rizzo |
Corporate Director | Sep 20, 2022 | |
| Amy Tovey |
Corporate Officer | Jul 27, 2015 | |
| Adam Waldron |
Corporate Director | Nov 5, 2011 | |
| Gloria Whiteside |
Corporate Director | Sep 22, 2014 | |
| Francee Reyes |
W-2 Managing Employee | Mar 6, 2023 | |
| Amelia Murphy |
Corporate Officer | Nov 14, 2015 | |
| Daniel Davids |
Corporate Director | Jun 26, 2017 | |
| Mindy Stosich-Benedetti |
Corporate Officer | May 15, 2006 | |
| Amber Davis |
Corporate Director | Jul 31, 2017 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Health West City Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Oct 1, 1975 |
| Indian Hills Elementary |
Federally qualified health center | Operational/Managerial Control | Apr 11, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240308003323 | WY | Part a Provider - Federally Qualified Health Center (FQHC) | 4981500931 | Practice locations: Evanston, WY |
| O20240905002758 | WY | Part B Supplier - Clinic/Group Practice | 4981500931 |
Receives reassigned benefits from 12 practitioners 1 other NPI on this enrollment Practice locations: Evanston, WY; Rock Springs, WY |
National Provider Directory
- Part of
- Health West Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
75 Yellow Creek Rd Ste 102
Evanston, WY 82930-5205
Mailing address
500 S 11TH Ave Ste 400
Pocatello, ID 83201-4880
Phone (208) 232-7862
Other names
- Health West Evanston
Other providers in Evanston, WY
- Jana Hartzell
- Lanaya Hatch
- Jacqueline Hayduk
- Health West, Inc.
- Health West, Inc.
- Cassie Heap
- Kira Heflebower
- Delynda Henderson
- High Country Behavioral Health
- High Country Behavioral Health
All providers in Evanston, WY · Federally Qualified Health Center (FQHC) in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.