NPIMap

Organization Active NPI

Saint Alphonsus Medical Center- Ontario Inc

  • Rural Health Clinic/Center
  • Fruitland, ID
National Provider Identifier
1760823397
Registry record updated Sep 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Practice address
910 NW 16TH St
Ste 101
Fruitland, ID 83619-2265
Phone
(208) 452-6851
NPI assigned
Jul 11, 2013
Organization subpart
Yes
Parent organization
SAINT ALPHONSUS MEDICAL CENTER ONTARIO INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 8, 2026

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

Authorized official

Name
Marcie Harper
Title
Cfo
Phone
(208) 367-7192

Specialties & licenses 1

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

Addresses

Primary practice location

910 NW 16TH St
Ste 101
Fruitland, ID 83619-2265

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-6275

Other names 1

  • Saint Alphonsus Medical Group Fruitland Health Plaza Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140610001779 ID Part A Provider - Rural Health Clinic 1456488899 1 other NPI on this enrollment
Practice locations: Fruitland, ID

Rural health clinic certification: CCN 138524

Legal name
SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC
Doing business as
SAINT ALPHONSUS FRUITLAND HEALTH PLAZA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 6, 2016
Last certification
Feb 6, 2016
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
910 NW 16TH St
Ste 101
Fruitland, ID 83619-2265
Related CCNs
380052

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).

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2049635Fruitland Health Plaza910 NW 16TH St #100, Fruitland, ID 83619Certificate of waiverApr 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Saint Alphonsus Med CNTR4 organizations share this tax ID, including this one
Part of
Saint Alphonsus Med CNTR

Other organizations with this tax ID 3

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 20

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

NameRoleSinceShare
William Edward Avey Individual Corporate DirectorBoard Member Jan 1, 2026
Brian L Checketts Individual Corporate OfficerCfo & Treasurer Dec 14, 2016
Tonja Lee Nielsen Individual Corporate DirectorBoard Member Jan 2, 2022
Connie Russell Tanaka Individual Corporate DirectorBoard Member Jan 1, 2026
Saint Alphonsus Health System Inc Organization, Boise, ID Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2010 100%
Elsbeth Mulvaney Individual Corporate DirectorBoard Member Jan 1, 2026
Marie Guadalupe Wissel Individual Corporate DirectorBoard Member Jan 1, 2020
Michael Coughlin Individual Corporate DirectorBoard Member Jan 1, 2022
Jason D Wright Individual Corporate DirectorBoard Member Jan 1, 2026
David McFadyen Individual Corporate OfficerPresident Jul 1, 2024
Corporate DirectorBoard Member Jul 1, 2024
Adam Richins Individual Corporate OfficerBoard Chair Jan 1, 2025
Corporate DirectorBoard Member Jan 1, 2022
Angela Faye Taylor Individual Corporate OfficerBoard Vice Chair Jan 1, 2025
Corporate DirectorBoard Member Jan 1, 2022
Stephanie C Westermeier Individual Corporate OfficerSecretary Jan 20, 2010
Irma Roci Valdivia Barba Individual Corporate DirectorBoard Member Jan 1, 2025
Robert Ladenburger Individual Corporate DirectorBoard Member Jan 1, 2023
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Apr 1, 2010 100%
Anthony Swart Individual Corporate OfficerVP Operations and Finance Oct 7, 2022
W-2 Managing EmployeeVP Operations and Finance Oct 7, 2022
Operational/Managerial ControlVP Operations and Finance Oct 7, 2022
Stuart Kilpinen Individual Operational/Managerial ControlChain Home Office Administrator Jun 10, 2023
Dina Ellwanger Individual Corporate OfficerCeo Aug 17, 2020
Corporate DirectorBoard Member Aug 17, 2020
Operational/Managerial ControlCeo Aug 17, 2020
Michael Joseph Ballantyne Individual Corporate DirectorBoard Member Mar 6, 2020

Owners & managing parties with NPI records 1

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

Facilities with the same owner 157

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

View all 157

Practitioners & affiliated clinicians

Practitioners 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1373500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788825600000",
    "number": "1760823397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-6275",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 NW 16TH ST",
            "address_2": "STE 101",
            "city": "FRUITLAND",
            "state": "ID",
            "postal_code": "836192265",
            "telephone_number": "208-452-6851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT ALPHONSUS MEDICAL CENTER- ONTARIO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAINT ALPHONSUS MEDICAL CENTER ONTARIO INC",
        "enumeration_date": "2013-07-11",
        "last_updated": "2026-09-08",
        "certification_date": "2026-09-08",
        "status": "A",
        "authorized_official_last_name": "HARPER",
        "authorized_official_first_name": "MARCIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "208-367-7192"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Saint Alphonsus Medical Group Fruitland Health Plaza",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Saint Alphonsus Medical Group Fruitland Health Plaza",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fruitland, ID

Sources for this page

Verify at the official NPI Registry.