NPIMap

Organization Active NPI

Carbon Medical Service Association, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Helper, UT
National Provider Identifier
1679749196
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Feb 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

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

Authorized official

Name
Carolyn Sue Abeyta
Title
Executive Director
Phone
(435) 888-4411

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679749196. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Nov 5, 1952 in UT
Enrollment address
125 S Main St
Helper, UT 84526-1535
Related CCNs
461801

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).

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D0958204Helper Clinic125 S Main St, Helper, UT 84526Provider-performed microscopyOct 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
Carbon Med Ser Assn5 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 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Crestina Trujillo Individual Corporate Officer Jan 21, 2013
Jeff Braby Individual Corporate Officer Feb 27, 2019
Jack Ori Individual Corporate Officer Oct 30, 2013
Don Logston Individual Corporate Officer Apr 30, 2013
Alyssa Wilberg Individual Corporate Officer Jul 13, 2013
Michael Oshea Individual Corporate Officer Jan 27, 2021
Ramona Holt Individual Corporate DirectorBoard Member Feb 20, 2013
Angelica Garcia Individual Corporate OfficerBoard Member Mar 23, 2022
Amanda Holley Individual Corporate OfficerBoard Member Apr 27, 2022
Kimalee Allred Individual Corporate Director Jun 29, 2017
Carolyn S. Abeyta Individual Corporate OfficerExecutiver Director Feb 20, 2013
W-2 Managing EmployeeExecutive Director Feb 20, 2013

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1679749196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 930",
            "city": "EAST CARBON",
            "state": "UT",
            "postal_code": "845200930",
            "telephone_number": "435-888-4411",
            "fax_number": "435-888-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 S MAIN ST",
            "city": "HELPER",
            "state": "UT",
            "postal_code": "845261535",
            "telephone_number": "435-472-7000",
            "fax_number": "435-472-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "ABEYTA",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "435-888-4411"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Helper, UT

Sources for this page

Verify at the official NPI Registry.