NPIMap

Organization Active NPI

Bear Lake Community Health Center, Inc.

Doing business as Bear Lake Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Garden City, UT
National Provider Identifier
1689754475
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BEAR LAKE COMMUNITY HEALTH CENTER, INC.
Doing business as
Bear Lake Community Health Center
Practice address
325 W. Logan Hwy
Garden City, UT 84028-0328
Phone
(435) 946-3660
Fax
(435) 946-8215
NPI assigned
Oct 16, 2006
Last updated
Jun 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Authorized official

Name
Jorge Garcia
Title
Ceo
Phone
(435) 755-6061

Specialties & licenses 1

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

Addresses

Primary practice location

325 W. Logan Hwy
Garden City, UT 84028-0328

Mailing address

517 W 100 N Ste 210
Providence, UT 84332-9826
Phone (435) 755-6061

Other names 1

  • Bear Lake Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040110000158 UT Part B Supplier - Clinic/Group Practice 9032020037 Receives reassigned benefits from 20 practitioners
2 other NPIs on this enrollment
Practice locations: Providence, UT; Randolph, UT; North Logan, UT; Garden City, UT; Brigham City, UT

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

Locations

152 S 4th St
Montpelier, ID 83254
Phone (208) 847-2108

26 W Main St
Ste 3A
Hyrum, UT 84319
Phone (435) 245-6248

944 S State Highway 89
Logan, UT 84321
Phone (435) 755-3432

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1689754475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 W 100 N STE 210",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329826",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W. LOGAN HWY",
            "city": "GARDEN CITY",
            "state": "UT",
            "postal_code": "840280328",
            "telephone_number": "435-946-3660",
            "fax_number": "435-946-8215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAR LAKE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "435-755-6061"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bear Lake Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garden City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.