Bear Lake Community Health Center, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BEAR LAKE COMMUNITY HEALTH CENTER, INC.

Doing business as

Bear Lake Community Health Center
Bear Lake Community Health Center- Montpelier
Bear Lake Community Health Center- Randolph5 more in Other names

Practice address

325 West Logan Highway
Garden City, UT 84028-8001

Phone

(435) 946-3660

Fax

(435) 946-8215

NPI assigned

Jan 28, 2010

Last updated

Jun 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jorge Garcia

Title

Ceo

Phone

(435) 755-6061

Specialties & licenses 14

Addresses

Other names 8

• Bear Lake Community Health Center Doing business as
• Bear Lake Community Health Center- Montpelier Doing business as
• Bear Lake Community Health Center- Randolph Doing business as
• Box Elder Community Health Center Doing business as
• Cache Valley Community Health Center Doing business as
• Cache Valley Community Health Center- Providence Doing business as
• Evanston Community Health Center Doing business as
• Rock Springs Community Health Center Doing business as

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Bear Lake Community Health Center, Inc.

  dba Box Elder Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Brigham City, UT
  • NPI 1558806125

  O20040110000158

  Same enrollment
• Bear Lake Community Health Center, Inc.

  dba Bear Lake Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Garden City, UT
  • NPI 1689754475

  O20040110000158

  Same enrollment

Locations

Practitioners 4

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.

• Ben P Boyer, FNP

  • Family Nurse Practitioner
  • Providence, UT
  • NPI 1477703338

  Family Medicine

  NPD
• Suezan L Johnson, LCSW

  • Clinical Social Worker
  • North Logan, UT
  • NPI 1770513962
  NPD
• Florin Rex Nielsen Jr., M.D.

  • Obstetrics & Gynecology Physician
  • Price, UT
  • NPI 1508811639
  NPD
• Mark C. Weston, DDS

  • Dentist
  • Garden City, UT
  • NPI 1114016250
  NPD

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

{
    "created_epoch": "1264636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654473600000",
    "number": "1629309786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 W 100 N STE 210",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329826",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 WEST LOGAN HIGHWAY",
            "city": "GARDEN CITY",
            "state": "UT",
            "postal_code": "840288001",
            "telephone_number": "435-946-3660",
            "fax_number": "435-946-8215"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 S Main St",
            "address_purpose": "LOCATION",
            "city": "Randolph",
            "state": "UT",
            "postal_code": "840647701",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "152 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Montpelier",
            "state": "ID",
            "postal_code": "832541538",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2620 Commercial Way Ste 140",
            "address_purpose": "LOCATION",
            "city": "Rock Springs",
            "state": "WY",
            "postal_code": "829014750",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 W 200 N",
            "address_purpose": "LOCATION",
            "city": "Brigham City",
            "state": "UT",
            "postal_code": "843022109",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "75 Yellow Creek Rd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Evanston",
            "state": "WY",
            "postal_code": "829305205",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1515 N 400 E Ste 104",
            "address_purpose": "LOCATION",
            "city": "North Logan",
            "state": "UT",
            "postal_code": "843417595",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "517 W 100 N Ste 110",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "UT",
            "postal_code": "843329826",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEAR LAKE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-28",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "435-755-6061"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P1300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist, Psychiatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Lake Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bear Lake Community Health Center- Montpelier",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bear Lake Community Health Center- Randolph",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Box Elder Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cache Valley Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cache Valley Community Health Center- Providence",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evanston Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rock Springs Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bear Lake Community Health Center Pharmacy
• Bear Lake Community Health Center, Inc. (Bear Lake Community Health Center)
• Bear Lake County Memorial Hospital (BLMH Bear Lake Clinic)
• Bear Lake Drug Garden City
• Bear Lake Physical and Sports Therapy PC
• Benjamin Charles Bosen, DO

• Family Medicine Physician in Garden City, UT
• Providers in Garden City, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.