NPIMap

Organization Active NPI

Prowers County Hospital District

Doing business as Lamar Medical Clinic

  • Rural Health Clinic/Center
  • Lamar, CO
National Provider Identifier
1649505074
Registry record updated May 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PROWERS COUNTY HOSPITAL DISTRICT
Doing business as
Lamar Medical Clinic
Practice address
403 Kendall Dr
Lamar, CO 81052-3953
Phone
(719) 336-6767
Fax
(719) 336-7217
NPI assigned
Oct 2, 2009
Last updated
May 27, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
PROWERS COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 27, 2010

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

Authorized official

Name
Mrs. Karen L Bryant
Title
Chief Operating Officer
Phone
(719) 336-5147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

403 Kendall Dr
Lamar, CO 81052-3953

Mailing address

403 Kendall Dr
Lamar, CO 81052-3953
Phone (719) 336-6767

Other names 1

  • Lamar Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091007000253 CO Part A Provider - Rural Health Clinic 4486568508 Practice locations: Lamar, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649505074. Details of each certification follow.

Rural health clinic certification: CCN 068512

Legal name
PROWERS COUNTY HOSPITAL DISTRICT
Doing business as
LAMAR MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 4, 2010
Last certification
Jul 13, 2023
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
403 Kendall Dr
Lamar Medical Clinic
Lamar, CO 81052-3953
Related CCNs
061323

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Prowers Medical Center6 organizations share this tax ID, including this one
Part of
Prowers Medical Center

Other organizations with this tax ID 5

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

Interoperability endpoints

  • Direct secure messaging: christine.bogardus@pmg.gwaydirect.com
  • Direct secure messaging: kimberly.collymore@pmg.gwaydirect.com
  • Direct secure messaging: scott.cameron@pmg.gwaydirect.com
  • Direct secure messaging: steven.foley@pmg.gwaydirect.com

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Lisa a Dodkins Individual W-2 Managing Employee Sep 1, 2022
Karen Bryant Individual W-2 Managing Employee Jan 26, 2009
Prowers County Hospital District Organization, Lamar, CO 5% Or Greater Direct Ownership Interest Jan 26, 2009
Tina Sandoval Individual Corporate OfficerChief Clinical Officer Aug 28, 2017 5%

Owners & managing parties with NPI records 2

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
Prowers Medical CenterLamar, CO, CCN 06Z323 Hospital 5% Or Greater Direct Ownership Interest Jan 6, 2009
Prowers Medical Center Home HealthLamar, CO, CCN 067295 Home health agency 5% Or Greater Direct Ownership Interest Dec 1, 2008

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1254441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274918400000",
    "number": "1649505074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 KENDALL DR",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523953",
            "telephone_number": "719-336-6767",
            "fax_number": "719-336-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 KENDALL DR",
            "city": "LAMAR",
            "state": "CO",
            "postal_code": "810523953",
            "telephone_number": "719-336-6767",
            "fax_number": "719-336-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROWERS COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROWERS COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2009-10-02",
        "last_updated": "2010-05-27",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "719-336-5147",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lamar Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lamar, CO

Sources for this page

Verify at the official NPI Registry.