NPIMap

Organization Active NPI

Bear Lake County Memorial Hospital

  • Skilled Nursing Facility
  • Montpelier, ID
National Provider Identifier
1659461531
Registry record updated May 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BEAR LAKE COUNTY MEMORIAL HOSPITAL
Practice address
164 S 5TH St
Montpelier, ID 83254-1557
Phone
(208) 847-4412
NPI assigned
Oct 13, 2006
Last updated
May 19, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2010

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

Authorized official

Name
Ryan Messerly
Title
PFS Director
Phone
(208) 847-4429

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

164 S 5TH St
Montpelier, ID 83254-1557

Mailing address

164 South 5TH
Montpelier, ID 83254
Phone (208) 847-4412

Other names 1

  • Bear Lake Memorial Swing Bed Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071009000617 ID Part A Provider - Critical Access Hospital 5395799860 Practice locations: Montpelier, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659461531. Details of each certification follow.

Hospital certification: CCN 13Z316

Legal name
BEAR LAKE COUNTY MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
164 S 5TH St
Montpelier, ID 83254-1557
Other Hospital Practice Location

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

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
Shaun Tobler10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Bear Lake County Organization, Paris, ID 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
Leslie Crane Individual Corporate OfficerCfo Jun 28, 2009
W-2 Managing EmployeeCfo Jun 28, 2009
Michael D Blauer Individual Corporate Officer Jan 1, 2022
W-2 Managing Employee Jan 1, 2022

Owners & managing parties with NPI records 1

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

  • Bear Lake County

    dba Bear Lake County Ambulance Service

    • Ambulance
    • Montpelier, ID
    • NPI 1447311139

    5% Or Greater Direct Ownership Interest

    CMS ownership

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Bear Lake Memorial Skilled Nursing FacilityMontpelier, ID, CCN 135070 Skilled nursing facility Operational/Managerial Control
Direct Ownership Interest (100%)		 May 1, 1977
May 1, 1977
Bear Lake County Memorial Hospital Home HealthMontpelier, ID, CCN 137069 Home health agency Operational/Managerial Control (100%) Dec 14, 1993
Bear Lake Internal MedicineMontpelier, ID, CCN 138505 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966

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

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274227200000",
    "number": "1659461531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 SOUTH 5TH",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "83254",
            "telephone_number": "208-847-4412",
            "fax_number": "208-847-4428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 S 5TH ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541557",
            "telephone_number": "208-847-4412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR LAKE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2010-05-19",
        "status": "A",
        "authorized_official_last_name": "MESSERLY",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PFS DIRECTOR",
        "authorized_official_telephone_number": "208-847-4429"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Lake Memorial Swing Bed",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Montpelier, ID

Sources for this page

Verify at the official NPI Registry.