NPIMap

Organization Active NPI

Caribou Medical Center, Inc.

Doing business as Caribou Medical Center Swing Bed

  • Medicare Defined Swing Bed Hospital Unit
  • Soda Springs, ID
National Provider Identifier
1730859067
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
CARIBOU MEDICAL CENTER, INC.
Doing business as
Caribou Medical Center Swing Bed
Practice address
300 S 3Rd W
Soda Springs, ID 83276-1559
Phone
(208) 547-3341
Fax
(208) 547-2790
NPI assigned
Sep 17, 2021
Last updated
Sep 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

Name
Sheri Henderson
Title
Credentialing Specialist
Phone
(208) 547-0700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

300 S 3Rd W
Soda Springs, ID 83276-1559

Mailing address

300 S 3Rd W
Soda Springs, ID 83276-1559
Phone (208) 547-3341

Other names 1

  • Caribou Medical Center Swing Bed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211103000464 ID Part A Provider - Critical Access Hospital 7618365701 Practice locations: Soda Springs, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730859067. Details of each certification follow.

Hospital certification: CCN 13Z309

Legal name
CARIBOU MEDICAL CENTER, INC
Doing business as
CARIBOU MEDICAL CENTER SWING BED
Organization structure
OtherNon-profit
Incorporated
Aug 1, 2021 in ID
Enrollment address
300 S 3Rd W
Soda Springs, ID 83276-1559
Hospital Swing-Bed Unit

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).

National Provider Directory

National Provider Directory
Tax ID family
Caribou Medical Center Inc8 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.

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Wesley Brown Individual Corporate DirectorBoard of Director Aug 1, 2021
Alan Robinson Individual Contracted Managing EmployeeCfo Aug 1, 2021
Corporate OfficerCfo Aug 1, 2021
Brenda Bergholm Individual Corporate OfficerCco Aug 1, 2021
W-2 Managing EmployeeCco Aug 1, 2021
Sheri Henderson Individual W-2 Managing EmployeeCredentialing Specialist Aug 1, 2021
Charlene McCulloch Individual Corporate DirectorBoard of Director Sep 27, 2023
Stephanie Rindlisbaker Individual Corporate DirectorBoard of Director Mar 1, 2023
Rachel Capell Individual W-2 Managing EmployeeDirector of Patient Financial Serv Aug 1, 2021
Kristin Horsley Individual W-2 Managing EmployeeCredentialing Dec 14, 2023
Curtis Toone Individual Corporate DirectorBoard of Director Aug 31, 2022
Craig Mansfield Individual Corporate DirectorBoard of Director Aug 1, 2021
Caribou Medical Center, Inc Organization, Soda Springs, ID Non-profit Operational/Managerial Control Aug 1, 2021 100%
Kent D Loosle Individual Corporate OfficerCeo Nov 1, 2023
W-2 Managing EmployeeCeo Nov 1, 2023
Lorraine Myers Individual Corporate DirectorBoard of Director Aug 1, 2021

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Caribou Medical CenterSoda Springs, ID, CCN 131309 Hospital 5% Or Greater Indirect Ownership Interest (100%) Aug 1, 2021
Lakeview Medical ClinicSoda Springs, ID, CCN 138506 Rural health clinic Operational/Managerial Control (100%) Aug 1, 2021

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1730859067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S 3RD W",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761559",
            "telephone_number": "208-547-3341",
            "fax_number": "208-547-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 3RD W",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761559",
            "telephone_number": "208-547-3341",
            "fax_number": "208-547-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARIBOU MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "SHERI",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "208-547-0700"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caribou Medical Center Swing Bed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Soda Springs, ID

Sources for this page

Verify at the official NPI Registry.