NPIMap

Organization Active NPI

Summit Community Care Clinic, Inc.

Doing business as Elevated Community Health

  • Federally Qualified Health Center (FQHC)
  • Breckenridge, CO
National Provider Identifier
1639595986
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SUMMIT COMMUNITY CARE CLINIC, INC.
Doing business as
Elevated Community Health
Practice address
16201 Highway 9
Breckenridge, CO 80424-9444
Phone
(970) 668-4040
NPI assigned
Mar 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

Name
Josh Cogdill
Title
Ceo
Phone
(970) 668-4040

Specialties & licenses 1

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

Addresses

Primary practice location

16201 Highway 9
Breckenridge, CO 80424-9444

Mailing address

PO Box 4337
Frisco, CO 80443-4337
Phone (970) 668-4049

Other names 1

  • Elevated Community Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151028002083 CO Part A Provider - Federally Qualified Health Center (FQHC) 8022284074 Practice locations: Breckenridge, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639595986. Details of each certification follow.

Federally qualified health center certification: CCN 061957

Legal name
SUMMIT COMMUNITY CARE CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 27, 2015
Last certification
Oct 27, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 24, 2004 in CO
Enrollment address
16201 Highway 9
Breckenridge, CO 80424

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Summit Community Care Clinic Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Deb Crook Individual Corporate DirectorBoard Member Nov 18, 2014
Patricia Kopystianskyj Individual Corporate DirectorSecretary Sep 21, 2010
Anthony Pestello Individual Other Oct 29, 2017
Dana Cottrell Individual Corporate DirectorBoard Member Sep 21, 2010
Nicole Zador Individual Other Oct 27, 2021
Daniel Becker Individual Corporate OfficerInterim Ceo Oct 1, 2023
W-2 Managing EmployeeInterim Ceo Oct 1, 2023
Ursula Karina Zuniga Individual Other Oct 15, 2019
David Nicoli Individual Other Feb 23, 2017
Norman Stoller Individual Other Sep 22, 2015
Maryjo Zweig Individual Other Oct 24, 2018
Julie Thebeau Individual Other Oct 23, 2019
Richard O'Brien Individual Other Sep 21, 2015
Wilson Blake Individual Corporate DirectorBoard Member Oct 25, 2017
Braden McMillan Individual Other Jun 22, 2016
Judi Lapoint Individual OtherBoard Member Aug 7, 2023
Dustin Stokes Individual Other Oct 27, 2021
James K Beckmann Individual Other Oct 27, 2021

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1639595986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4337",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "804434337",
            "telephone_number": "970-668-4049",
            "fax_number": "970-668-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16201 HIGHWAY 9",
            "city": "BRECKENRIDGE",
            "state": "CO",
            "postal_code": "804249444",
            "telephone_number": "970-668-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT COMMUNITY CARE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "COGDILL",
        "authorized_official_first_name": "JOSH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-668-4040"
    },
    "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": "Elevated Community Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Breckenridge, CO

Sources for this page

Verify at the official NPI Registry.