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Southeast Colorado Hospital District

Organization Active NPI Rural Health Clinic/Center · Springfield, CO

NPI 1669565677 · NPPES record last updated Apr 21, 2021

Key facts

NPI
1669565677
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
SOUTHEAST COLORADO HOSPITAL DISTRICT
Practice address
900 Church St
Springfield, CO 81073-1636
Phone
(719) 523-6628
Fax
(719) 523-4513
NPI assigned
Oct 2, 2006
Organization subpart
Yes
Parent organization (as reported)
SOUTHEAST COLORADO HOSPITAL DISTRICT

Authorized official

Name
Carla Forrest
Title
Him Director
Phone
(719) 523-2125

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 5

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 3

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

Corporate family (same tax ID) 8

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

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

Facilities with the same owner 2

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

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CO

Rural health clinic certification: CCN 063998

Legal name
SOUTHEAST COLORADO HOSPITAL DISTRICT
Doing business as
SOUTHEAST COLORADO HOSPITAL DISTRICT PHYSICIANS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 30, 2000
Last certification
Sep 24, 2025
Ownership / control type
2A
Organization structure
Other · Non-profit
Enrollment address
900 Church St
Southeast Colorado Hospital District Physicians CL
Springfield, CO 81073-1636
Related CCNs
061311

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
Heather Burdick
Individual 		Corporate Director
Director of Nursing		 Jan 1, 2021
Southeast Colorado Hospital District
Organization · Springfield, CO 		Operational/Managerial Control Jun 18, 2010
Anthony Brocato
Individual 		Contracted Managing Employee
Chief Executive Officer		 May 11, 2026
Corporate Officer
Chief Executive Officer		 May 11, 2026

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Southeast Colorado Hospital District
Springfield, CO · CCN 061311		 Hospital 5% Or Greater Direct Ownership Interest Mar 1, 2001
Southeast Colorado Hospital District
Springfield, CO · CCN 06Z311		 Hospital 5% Or Greater Direct Ownership Interest Mar 1, 2001
Southeast Colorado Hospital District
Springfield, CO · CCN 061530		 Hospice 5% Or Greater Direct Ownership Interest Jun 28, 1994

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040310001440 CO Part B Supplier - Clinic/Group Practice 6204725138 Receives reassigned benefits from 13 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Springfield, CO
O20041215000137 CO Part a Provider - Rural Health Clinic 6204725138 Practice locations: Springfield, CO

National Provider Directory

Tax ID family
SE Colorado Hospital (9 organizations share this tax ID)
Part of
SE Colorado Hospital

Locations

373 E 10th Ave
Springfield, CO 81073
Phone (719) 523-4501

Specialties & licenses

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

Addresses

Primary practice location

900 Church St
Springfield, CO 81073-1636

Mailing address

373 E 10TH Ave
Springfield, CO 81073-1622
Phone (719) 523-6628

Other providers in Springfield, CO

All providers in Springfield, CO · Rural Health Clinic/Center in Colorado

Sources for this page

Verify at the official NPI Registry.