NPIMap

Organization Active NPI

St. Mary's Hospital Inc

Doing business as St. Mary's Health

  • Family Medicine Physician
  • Craigmont, ID
National Provider Identifier
1770521817
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ST. MARY'S HOSPITAL INC
Doing business as
St. Mary's Health
Practice address
320 N Division
Craigmont, ID 83523
Phone
(208) 924-5504
Fax
(208) 924-5762
NPI assigned
Jun 2, 2006
Last updated
Aug 10, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
KOOTENAI HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

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

Authorized official

Name
Lenne Bonner
Title
Ceo
Phone
(208) 476-8008

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

320 N Division
Craigmont, ID 83523

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-5085

Other names 1

  • St. Mary's Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050316000814 ID Part B Supplier - Clinic/Group Practice 5092773168 Receives reassigned benefits from 98 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cottonwood, ID; Craigmont, ID; Grangeville, ID; Kamiah, ID; Nezperce, ID
O20061104000429 ID Part A Provider - Critical Access Hospital 5092773168 Receives reassigned benefits from 55 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cottonwood, ID; Nezperce, ID; Kamiah, ID; Grangeville, ID; Elk City, ID; Craigmont, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770521817. Details of each certification follow.

Hospital certification: CCN 131321

Legal name
ST MARYS HOSPITAL INC
Doing business as
ST. MARY'S HEALTH
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2003
Last certification
Mar 8, 2019
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 28, 1995 in ID
Enrollment address
701 Lewiston St
Cottonwood, ID 83522-9750

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

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
St Mary's HospitalCCN 131321 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
13D1047840St Mary's Health - Craigmont Clinic320 N Division St, Craigmont, ID 83523Provider-performed microscopyFeb 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
St Mary's Hospital Crna14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Cynthia O'Brien Individual Corporate DirectorBoard Member Apr 1, 2020
Lenne J Bonner Individual Corporate OfficerCeo Sep 1, 2006
W-2 Managing EmployeeCeo Sep 1, 2006
Rene Forsman Individual Corporate DirectorBoard Member Apr 1, 2020
Jon Ness Individual OtherCeo Apr 1, 2020
Leonard Hill Individual Corporate DirectorBoard Member Apr 1, 2020
Matt Sartini Individual Corporate DirectorBoard Member Apr 1, 2020
Barbara Jean Glodowski Individual Corporate DirectorBoard Member Apr 1, 2020
Lisa Maurer Individual Corporate DirectorBoard Member Apr 1, 2020
Christina Ulmer Individual Corporate DirectorBoard Member Apr 1, 2020
Clarence J Brunson Individual Corporate DirectorBoard Member Apr 1, 2020
Kootenai Health, Inc. Organization, Coeur D Alene, ID 5% Or Greater Direct Ownership Interest Apr 1, 2020 100%
Jeremy Evans Individual Corporate DirectorBoard Member Apr 1, 2020
Kimberly Ingram Individual Corporate DirectorBoard Member Apr 1, 2020
Kelly J McGrath Individual Corporate DirectorBoard Member Apr 1, 2020

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 32

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 32

Affiliated clinicians 117

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

View all 117

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786320000000",
    "number": "1770521817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-5085",
            "fax_number": "208-625-5731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 N DIVISION",
            "city": "CRAIGMONT",
            "state": "ID",
            "postal_code": "83523",
            "telephone_number": "208-924-5504",
            "fax_number": "208-924-5762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARY'S HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KOOTENAI HEALTH, INC.",
        "enumeration_date": "2006-06-02",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A",
        "authorized_official_last_name": "BONNER",
        "authorized_official_first_name": "LENNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-476-8008"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Craigmont, ID

Sources for this page

Verify at the official NPI Registry.