Carbon Medical Service Association, Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Helper, UT
NPI 1679749196 · NPPES record last updated Feb 4, 2021
Key facts
- NPI
- 1679749196
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
- Practice address
- 125 S Main St
Helper, UT 84526-1535 - Phone
- (435) 472-7000
- Fax
- (435) 472-3208
- NPI assigned
- May 5, 2008
- Organization subpart
- No
Authorized official
- Name
- Carolyn Sue Abeyta
- Title
- Executive Director
- Phone
- (435) 888-4411
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 4
Related certifications (CCN) 1
Practitioners 19
-
Matthew Frank Brady, M.D.
-
Jessica Garner, PMHNP-BC, FNP-BC
-
Dannette H Moynier, LCSW
-
Timothy Adam Callahan, P.A.C.
-
Devin W Edwards, CSW
-
Christopher D. Keil, SSW
-
Marvin Joseph Morrison, APRN
-
Jordan Trent Tatton, DNP
-
Danielle Marie Smith, FNP-C
-
Gypsie Marie Delgado, LCSW
-
Jonathan Blair Gardner, D.D.S.
-
Wilford Jay Stilson, D.M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D0958204 | Helper Clinic | Provider-performed microscopy | Oct 22, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT
Federally qualified health center certification: CCN 461822
- Legal name
- CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
- Doing business as
- CARBON MEDICAL SERVICE HELPER CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 17, 2003
- Last certification
- Oct 17, 2003
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Nov 5, 1952 in UT
- Enrollment address
- 125 S Main St
Helper, UT 84526-1535 - Related CCNs
- 461801
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Crestina Trujillo |
Corporate Officer | Jan 21, 2013 | |
| Jeff Braby |
Corporate Officer | Feb 27, 2019 | |
| Jack Ori |
Corporate Officer | Oct 30, 2013 | |
| Don Logston |
Corporate Officer | Apr 30, 2013 | |
| Alyssa Wilberg |
Corporate Officer | Jul 13, 2013 | |
| Michael Oshea |
Corporate Officer | Jan 27, 2021 | |
| Ramona Holt |
Corporate Director |
Feb 20, 2013 | |
| Angelica Garcia |
Corporate Officer |
Mar 23, 2022 | |
| Amanda Holley |
Corporate Officer |
Apr 27, 2022 | |
| Kimalee Allred |
Corporate Director | Jun 29, 2017 | |
| Carolyn S. Abeyta |
Corporate Officer |
Feb 20, 2013 | |
| W-2 Managing Employee |
Feb 20, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050606001229 | UT | Part B Supplier - Clinic/Group Practice | 4183535115 |
Receives reassigned benefits from 21 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Helper, UT; Sunnyside, UT; Price, UT |
| O20090210000272 | UT | Part a Provider - Federally Qualified Health Center (FQHC) | 4183535115 | Practice locations: Helper, UT |
National Provider Directory
- Tax ID family
- Carbon Medical Service Association Incorported
Locations
125 S Main St
Helper, UT 84526
Phone (435) 472-7000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Multi-Specialty Clinic/Center | 261QM1300X |
Addresses
Primary practice location
125 S Main St
Helper, UT 84526-1535
Mailing address
PO Box 930
East Carbon, UT 84520-0930
Phone (435) 888-4411
Other providers in Helper, UT
- David Keith Arthur
- Kourtney Atwood
- Jennifer Ann Buttrick
- Carbon Medical Service Association Incorporated
- Trent Benjamin Greenhalgh
- Russell Lee Hunt
- Life Happens Counseling
- Parkway Dental - Helper LLC
- Drew Pitcher
All providers in Helper, UT · Federally Qualified Health Center (FQHC) in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.