NPIMap

Organization Active NPI

Fallon Medical Complex Inc

Doing business as Community Clinic

  • Rural Health Clinic/Center
  • Baker, MT
National Provider Identifier
1700895752
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
FALLON MEDICAL COMPLEX INC
Doing business as
Community Clinic
Practice address
202 South 4TH Street West
Baker, MT 59313-1119
Phone
(406) 778-2833
Fax
(406) 778-5155
NPI assigned
Aug 7, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Selena R Nelson
Title
Cfo
Phone
(406) 778-5103

Specialties & licenses 1

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

Addresses

Primary practice location

202 South 4TH Street West
Baker, MT 59313-1119

Mailing address

PO Box 1119
202 South 4TH Street West
Baker, MT 59313-1119
Phone (406) 778-2833

Other names 1

  • Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051013000381 MT Part A Provider - Rural Health Clinic 0941119499 Practice locations: Baker, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700895752. Details of each certification follow.

Rural health clinic certification: CCN 273981

Legal name
FALLON MEDICAL COMPLEX INC
Doing business as
COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 1994
Last certification
Aug 16, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1991 in MT
Enrollment address
202 S 4TH St W
Baker, MT 59313-9156
Related CCNs
271301

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).

National Provider Directory

National Provider Directory
Tax ID family
Fallon Medical Complex8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Erin M Lutts Individual Corporate DirectorBoard Member Jun 1, 2023
David Kirschten Individual Corporate DirectorBoard Member Jan 1, 2023
Elaine Stanhope Individual Corporate DirectorBoard Member Jan 1, 2023
David E Espeland Individual Corporate OfficerChief Executive Officer Aug 5, 1995 100%
W-2 Managing EmployeeChief Executive Officer Aug 5, 1995
Evelyn K Neary Individual Corporate DirectorBoard Member Jan 1, 2023
Marjorie M Losing Individual Corporate OfficerChief Financial Officer May 1, 2017 25%
W-2 Managing EmployeeCfo Jul 18, 2016 25%
Curt Arnell Individual Corporate DirectorBoard Member Mar 2, 2022
Susan L Stevens Individual W-2 Managing EmployeeCredentialing Manager Apr 1, 2017
Michele Gray Individual Corporate DirectorBoard Member Jan 1, 2024
Del Espinosa Individual Corporate DirectorBoard Member Jan 1, 2024

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700895752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1119",
            "address_2": "202 SOUTH 4TH STREET WEST",
            "city": "BAKER",
            "state": "MT",
            "postal_code": "593131119",
            "telephone_number": "406-778-2833",
            "fax_number": "406-778-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 SOUTH 4TH STREET WEST",
            "city": "BAKER",
            "state": "MT",
            "postal_code": "593131119",
            "telephone_number": "406-778-2833",
            "fax_number": "406-778-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FALLON MEDICAL COMPLEX INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "SELENA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "406-778-5103"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baker, MT

Sources for this page

Verify at the official NPI Registry.