NPIMap

Organization Active NPI

Upper San Juan Health Service District

Doing business as Pagosa Springs Medical Center

  • Rural Health Clinic/Center
  • Pagosa Springs, CO
National Provider Identifier
1659507150
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
01Y763 Issued in CO
Legal business name
UPPER SAN JUAN HEALTH SERVICE DISTRICT
Doing business as
Pagosa Springs Medical Center
Practice address
95 S Pagosa Blvd
Pagosa Springs, CO 81147-8329
Phone
(970) 731-3700
Fax
(970) 731-3707
NPI assigned
Jun 10, 2009
Last updated
Jun 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Authorized official

Name
Rhonda Webb, MDNPI 1598762494
Title
Ceo, Cmo
Phone
(970) 731-3700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 01Y763 CO Primary

Addresses

Primary practice location

95 S Pagosa Blvd
Pagosa Springs, CO 81147-8329

Mailing address

95 S Pagosa Blvd
Pagosa Springs, CO 81147-8329
Phone (970) 731-3700

Other names 1

  • Pagosa Springs Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090713000551 CO Part A Provider - Rural Health Clinic 2769571892 Practice locations: Pagosa Springs, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659507150. Details of each certification follow.

Rural health clinic certification: CCN 068509

Legal name
UPPER SAN JUAN HEALTH SERVICE DISTRICT
Doing business as
PAGOSA SPRINGS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 14, 2010
Last certification
Sep 28, 2023
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
95 S Pagosa Blvd
Pagosa Springs, CO 81147-8329
Related CCNs
061328

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
Upper San Juan Hosd Am5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

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
Michelle Keplinger Individual Corporate Officer Apr 30, 2018
Upper San Juan Health Service District Organization, Pagosa Springs, CO 5% Or Greater Direct Ownership Interest Jul 1, 2009
Rhonda P Webb Individual Corporate OfficerCeo, Cmo Jan 1, 2018
Ann Bruzzese Individual Corporate OfficerCao Feb 1, 2015
W-2 Managing EmployeeAd; Feb 1, 2015

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 1

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

FacilityTypeRoleSince
Pagosa Springs Medical CenterPagosa Springs, CO, CCN 061328 Hospital Operational/Managerial Control Aug 30, 1984

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1244592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719187200000",
    "number": "1659507150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 S PAGOSA BLVD",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811478329",
            "telephone_number": "970-731-3700",
            "fax_number": "970-731-3707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 S PAGOSA BLVD",
            "city": "PAGOSA SPRINGS",
            "state": "CO",
            "postal_code": "811478329",
            "telephone_number": "970-731-3700",
            "fax_number": "970-731-3707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER SAN JUAN HEALTH SERVICE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-10",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "WEBB",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "CEO, CMO",
        "authorized_official_telephone_number": "970-731-3700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CO",
            "license": "01Y763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pagosa Springs Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pagosa Springs, CO

Sources for this page

Verify at the official NPI Registry.