NPIMap

Organization Active NPI

Health West, Inc.

Doing business as Health West Evanston

  • Federally Qualified Health Center (FQHC)
  • Evanston, WY
National Provider Identifier
1619683547
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH WEST, INC.
Doing business as
Health West Evanston
Practice address
75 Yellow Creek Rd Ste 102
Evanston, WY 82930-5205
Phone
(307) 789-8290
NPI assigned
Jan 24, 2023
Last updated
Jan 24, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTH WEST, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Authorized official

Name
Amelia Murphy
Title
Medical Staff Coordinator
Phone
(208) 232-7862

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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 1

  • Health West Evanston Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619683547. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Oct 1, 1975 in ID
Enrollment address
75 Yellow Creek Rd
Ste 102
Evanston, WY 82930-5205

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Lakeview Medical Clinic

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Nichole Wortham Individual Corporate Officer Jun 11, 2020
Alyson Later Individual W-2 Managing Employee May 26, 2022
Carol Gilbert Individual Corporate Officer Nov 30, 2023
Amy Wuest Individual Corporate Director Sep 14, 2022
Doug Mathis Individual Corporate Director Jul 27, 2015
Iris Buder Individual Corporate Director Nov 23, 2015
Mark T Horrocks Individual Corporate Officer Oct 30, 2002
Larry Burden Individual Corporate Director Aug 24, 2021
Irene Barrett Individual Corporate Director Apr 27, 2021
Paul Morgan Individual Corporate Officer Jul 10, 2017
Charles Rizzo Individual Corporate Director Sep 20, 2022
Amy Tovey Individual Corporate Officer Jul 27, 2015
Adam Waldron Individual Corporate Director Nov 5, 2011
Gloria Whiteside Individual Corporate Director Sep 22, 2014
Francee Reyes Individual W-2 Managing Employee Mar 6, 2023
Amelia Murphy Individual Corporate Officer Nov 14, 2015
Daniel Davids Individual Corporate Director Jun 26, 2017
Mindy Stosich-Benedetti Individual Corporate Officer May 15, 2006
Amber Davis Individual Corporate Director Jul 31, 2017

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Health West City CenterPocatello, ID, CCN 131884 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 1, 1975
Indian Hills ElementaryPocatello, ID, CCN 131887 Federally qualified health center Operational/Managerial Control Apr 11, 2026

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1674518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1619683547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 S 11TH AVE STE 400",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014880",
            "telephone_number": "208-232-7862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 YELLOW CREEK RD STE 102",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829305205",
            "telephone_number": "307-789-8290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH WEST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTH WEST, INC.",
        "enumeration_date": "2023-01-24",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "MURPHY",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "MEDICAL STAFF COORDINATOR",
        "authorized_official_telephone_number": "208-232-7862"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health West Evanston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evanston, WY

Sources for this page

Verify at the official NPI Registry.