NPIMap

Organization Active NPI

Southwest Colorado Mental Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Gunnison, CO
National Provider Identifier
1619729233
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHWEST COLORADO MENTAL HEALTH CENTER INC
Practice address
710 N Taylor St
Gunnison, CO 81230-2244
Phone
(970) 252-3200
NPI assigned
Apr 5, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Alex Conrad
Title
Cfo
Phone
(000) 000-0000

Specialties & licenses 1

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

Addresses

Primary practice location

710 N Taylor St
Gunnison, CO 81230-2244

Mailing address

PO Box 1328
Durango, CO 81302-1328
Phone (970) 335-2342

Other names 2

  • Axis Health System Doing business as
  • Axis Health System Gunnison Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326001177 CO Part B Supplier - Clinic/Group Practice 9133011802 Receives reassigned benefits from 95 practitioners
46 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gunnison, CO; Montrose, CO; Norwood, CO; Pagosa Springs, CO; Telluride, CO; Crested Butte, CO; Durango, CO; Dove Creek, CO…
O20240828003071 CO Part A Provider - Federally Qualified Health Center (FQHC) 9133011802 Practice locations: Gunnison, CO

Federally qualified health center certification: CCN 061073

Legal name
SOUTHWEST COLORADO MENTAL HEALTH CENTER INC
Doing business as
AXIS HEALTH SYSTEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 25, 2024
Last certification
Jul 25, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
710 N Taylor St
Gunnison, CO 81230-2244

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 41

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

View all 41

National Provider Directory

National Provider Directory
Tax ID family
Pinon Mesa Guidance Cen50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

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
John Albright Individual Other Feb 1, 2000
Robert Yearout Individual Other Nov 1, 2016
Charles R Forth Individual Other Oct 1, 2014
Frances Perrin Individual Other Jun 23, 2021
William August Westerman Individual Other Nov 20, 2019
Janet Petty Individual Corporate Director Dec 1, 2023
Lisa Hanson Individual W-2 Managing EmployeeReimbursement Specialist Apr 24, 2020
Alyssa Nicholle Stock Individual W-2 Managing Employee Jan 7, 2020
Paul Nazaryk Individual Other Dec 1, 2016
Alex Durham Individual Other Apr 15, 2022
Marissa Talamante Individual Other May 1, 2019
Makaila Boschert Individual W-2 Managing Employee Mar 31, 2020
Alex Conrad Individual Operational/Managerial Control Jun 12, 2020
Shelly Burke Individual Corporate Director Oct 11, 2000
Amanda Miller Individual Other Apr 1, 2016
Southwest Colorado Mental Health Center Inc Organization, Durango, CO Corporation, Non-profit Operational/Managerial Control Oct 7, 2021
Karen Sheek Individual Other Jun 23, 2021
Robert Juskevich Individual Other Jul 1, 2014
Rob McNutt Individual Other Apr 1, 2022

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Axis Health SystemPagosa Springs, CO, CCN 061028 Federally qualified health center Operational/Managerial Control Oct 7, 2021
Axis Health SystemDurango, CO, CCN 061074 Federally qualified health center Operational/Managerial Control Oct 7, 2021
Axis Health SystemTelluride, CO, CCN 061082 Federally qualified health center Operational/Managerial Control Oct 7, 2021

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 67

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 67

NPI Registry JSON

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

{
    "created_epoch": "1712275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1619729233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1328",
            "city": "DURANGO",
            "state": "CO",
            "postal_code": "813021328",
            "telephone_number": "970-335-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N TAYLOR ST",
            "city": "GUNNISON",
            "state": "CO",
            "postal_code": "812302244",
            "telephone_number": "970-252-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST COLORADO MENTAL HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-05",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "000-000-0000"
    },
    "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": "Axis Health System",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Axis Health System Gunnison",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gunnison, CO

Sources for this page

Verify at the official NPI Registry.