NPIMap

Organization Active NPI

Sunrise Community Health

Doing business as SummitStone Clinic

  • Federally Qualified Health Center (FQHC)
  • Loveland, CO
National Provider Identifier
1750660726
Registry record updated May 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SUNRISE COMMUNITY HEALTH
Doing business as
SummitStone Clinic
Practice address
1250 N Wilson Ave
Loveland, CO 80537-4461
Phone
(970) 494-9789
Fax
(970) 663-0073
NPI assigned
Aug 9, 2011
Last updated
May 29, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNRISE COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2023

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

Authorized official

Name
Cathy Wolff
Title
Cfo
Phone
(970) 346-2546

Specialties & licenses 1

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

Addresses

Primary practice location

1250 N Wilson Ave
Loveland, CO 80537-4461

Mailing address

2930 11TH Ave
Evans, CO 80620-1011

Other identifiers 1

IdentifierTypeStateIssuer
25758241MedicaidCO

Other names 1

  • SummitStone Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040329001864 CO Part B Supplier - Clinic/Group Practice 0648164780 Receives reassigned benefits from 70 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Windsor, CO; Loveland, CO; Greeley, CO; Evans, CO
O20120106000851 CO Part A Provider - Federally Qualified Health Center (FQHC) 0648164780 Practice locations: Loveland, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750660726. Details of each certification follow.

Federally qualified health center certification: CCN 061919

Legal name
SUNRISE COMMUNITY HEALTH
Doing business as
SUNRISE SUMMITSTONE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2012
Last certification
Feb 24, 2012
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 1973 in CO
Enrollment address
1250 N Wilson Ave
Loveland, CO 80537-4461

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Part of
Sunrise Community Health

Locations

201 W 69th Ct
Loveland, CO 80538
Phone (970) 669-7500

1039 Main St
Windsor, CO 80550

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Mitzi M Moran Individual Corporate OfficerChief Executive Officer Sep 14, 1998 100%
W-2 Managing Employee Aug 1, 2006
Marilyn Schock Individual Corporate Officer Nov 30, 2014
Debra L Scott Individual Corporate Officer Jul 1, 2011 100%
W-2 Managing EmployeeAssociate Director Mar 1, 2015
Libby Goode-Grasmick Individual Corporate OfficerCoo Mar 15, 2015
W-2 Managing EmployeeCoo Mar 15, 2015
Mary C Wolff Individual Corporate OfficerCfo Jan 10, 2022 100%
Mark Wallace Individual Corporate Officer Jul 1, 2011 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
Sunrise North Range ClinicGreeley, CO, CCN 061910 Federally qualified health center Operational/Managerial Control Mar 28, 2005

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1312848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685318400000",
    "number": "1750660726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 11TH AVE",
            "city": "EVANS",
            "state": "CO",
            "postal_code": "806201011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 N WILSON AVE",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805374461",
            "telephone_number": "970-494-9789",
            "fax_number": "970-663-0073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNRISE COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNRISE COMMUNITY HEALTH",
        "enumeration_date": "2011-08-09",
        "last_updated": "2023-05-29",
        "certification_date": "2023-05-29",
        "status": "A",
        "authorized_official_last_name": "WOLFF",
        "authorized_official_first_name": "CATHY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "970-346-2546"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25758241",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SummitStone Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.