NPIMap

Organization Active NPI

Southeast Colorado Hospital District

  • Rural Health Clinic/Center
  • Springfield, CO
National Provider Identifier
1669565677
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 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
Last updated
Apr 21, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHEAST COLORADO HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Authorized official

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

Specialties & licenses 1

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

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669565677. Details of each certification follow.

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
OtherNon-profit
Enrollment address
900 Church St
Southeast Colorado Hospital District Physicians CL
Springfield, CO 81073-1636
Related CCNs
061311

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Southeast Co Hosptial9 organizations share this tax ID, including this one
Part of
Southeast Co Hosptial

Other organizations with this tax ID 8

Organizations that report the same tax identification number in 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
Heather Burdick Individual Corporate DirectorDirector of Nursing Jan 1, 2021
Southeast Colorado Hospital District Organization, Springfield, CO Operational/Managerial Control Jun 18, 2010
Anthony Brocato Individual Contracted Managing EmployeeChief Executive Officer May 11, 2026
Corporate OfficerChief Executive Officer May 11, 2026

Owners & managing parties with NPI records 3

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

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

Owned or controlled facilities with NPI records 5

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 2

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": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1669565677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "373 E 10TH AVE",
            "city": "SPRINGFIELD",
            "state": "CO",
            "postal_code": "810731622",
            "telephone_number": "719-523-6628",
            "fax_number": "719-523-4513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 CHURCH ST",
            "city": "SPRINGFIELD",
            "state": "CO",
            "postal_code": "810731636",
            "telephone_number": "719-523-6628",
            "fax_number": "719-523-4513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST COLORADO HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHEAST COLORADO HOSPITAL DISTRICT",
        "enumeration_date": "2006-10-02",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "FORREST",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "HIM DIRECTOR",
        "authorized_official_telephone_number": "719-523-2125"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, CO

Sources for this page

Verify at the official NPI Registry.