NPIMap

Rangely Hospital District

Organization Active NPI Family Medicine Physician · Rangely, CO

NPI 1730108747 · NPPES record last updated Dec 10, 2021

Key facts

NPI
1730108747
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
RANGELY HOSPITAL DISTRICT
Practice address
225 Eagle Crest Drive
Rangely, CO 81648-2109
Phone
(970) 675-5011
NPI assigned
Jul 19, 2006
Organization subpart
No

Authorized official

Name
Kyle Wren
Title
Ceo
Phone
(970) 675-5011

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 3

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

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

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CO

Rural health clinic certification: CCN 068524

Legal name
RANGELY HOSPITAL DISTRICT
Doing business as
RANGELY FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 30, 2021
Last certification
Mar 27, 2024
Ownership / control type
1B
Organization structure
Government · Non-profit
Incorporated
Jan 1, 1975 in CO
Enrollment address
225 Eagle Crest Dr
Rangely, CO 81648-3105
Related CCNs
061307

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kyle Wren
Individual 		Corporate Officer
Chief Executive Officer		 Nov 13, 2020 100%
Operational/Managerial Control Nov 13, 2020 100%
Rangely Hospital District
Organization · Rangely, CO 		5% Or Greater Direct Ownership Interest Jan 1, 1975 100%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Rangely Family Medicine
Rangely, CO · CCN 068524		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1975

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040310000452 CO Part B Supplier - Clinic/Group Practice 6103714175 Receives reassigned benefits from 20 practitioners
Practice locations: Rangely, CO
O20210713004059 CO Part a Provider - Rural Health Clinic 6103714175 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rangely, CO

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

225 Eagle Crest Drive
Rangely, CO 81648-2109

Mailing address

225 Eagle Crest Drive
Rangely, CO 81648-2109
Phone (970) 675-5011

Other identifiers

IdentifierTypeStateIssuer
04997045MedicaidCO

Other names

  • Rangely Family Medicine Doing business as

Other providers in Rangely, CO

All providers in Rangely, CO · Family Medicine Physician in Colorado

Sources for this page

Verify at the official NPI Registry.