NPIMap

Organization Active NPI

Bear Lake County Memorial Hospital

  • Home Health Agency
  • Montpelier, ID
National Provider Identifier
1669521084
Registry record updated Jul 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
HH107 Issued in ID
Legal business name
BEAR LAKE COUNTY MEMORIAL HOSPITAL
Practice address
164 S 5TH St
Montpelier, ID 83254-1557
Phone
(208) 847-4454
Fax
(208) 847-4414
NPI assigned
Jan 9, 2007
Last updated
Jul 14, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
BEAR LAKE COUNTY MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2015

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

Authorized official

Name
Mrs. Shauna Dawes
Title
Director of Home Health
Phone
(208) 847-4454

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HH107 ID Primary

Addresses

Primary practice location

164 S 5TH St
Montpelier, ID 83254-1557

Mailing address

164 S 5TH St
Montpelier, ID 83254-1557
Phone (208) 847-4454

Other identifiers 1

IdentifierTypeStateIssuer
002853200MedicaidID

Other names 1

  • Bear Lake County Memorial Home Health Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050503001168 ID Part A Provider - Home Health Agency 5395799860 Practice locations: Montpelier, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669521084. Details of each certification follow.

Home health agency certification: CCN 137069

Legal name
BEAR LAKE COUNTY MEMORIAL HOSPITAL
Doing business as
BEAR LAKE COUNTY MEMORIAL HOSPITAL HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Dec 14, 1993
Last certification
Feb 20, 2020
Ownership / control type
Non-Profit
Organization structure
OtherNon-profit
Enrollment address
164 S 5TH St
Montpelier, ID 83254-1557

Other NPIs with the same Medicare PAC ID 7

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Bear Lake Memorial Hospital Home HealthCCN 137069 · All quality measures
Overall star rating
2.5 of 5
Ownership
Non-Profit
Certified
Dec 14, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology

National Provider Directory

National Provider Directory
Tax ID family
Bear Lake Mem Hosp Crna10 organizations share this tax ID, including this one
Part of
Bear Lake Mem Hosp Crna

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 Dec 14, 1993 100%
Leslie Crane Individual W-2 Managing Employee Jun 28, 2009
Bear Lake County Memorial Hospital Organization, Montpelier, ID Non-profit Operational/Managerial Control Dec 14, 1993 100%

Owners & managing parties with NPI records 8

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
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 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 2

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

Facilities with the same owner 5

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.

Affiliated clinicians 3

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": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436832000000",
    "number": "1669521084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 S 5TH ST",
            "city": "MONTPELIER",
            "state": "ID",
            "postal_code": "832541557",
            "telephone_number": "208-847-4454",
            "fax_number": "208-847-4414"
        },
        {
            "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": "208-847-4454",
            "fax_number": "208-847-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR LAKE COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEAR LAKE COUNTY MEMORIAL HOSPITAL",
        "enumeration_date": "2007-01-09",
        "last_updated": "2015-07-14",
        "status": "A",
        "authorized_official_last_name": "DAWES",
        "authorized_official_first_name": "SHAUNA",
        "authorized_official_title_or_position": "DIRECTOR OF HOME HEALTH",
        "authorized_official_telephone_number": "208-847-4454",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "ID",
            "license": "HH107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002853200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Lake County Memorial Home Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Montpelier, ID

Sources for this page

Verify at the official NPI Registry.