NPIMap

Organization Active NPI

Mountainlands Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Vernal, UT
National Provider Identifier
1801226907
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAINLANDS COMMUNITY HEALTH CENTER INC
Practice address
1680 W Highway 40
Suite 201
Vernal, UT 84078-4135
Phone
(801) 429-2000
Fax
(801) 429-2001
NPI assigned
Nov 26, 2013
Last updated
Mar 27, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MOUNTAINLANDS COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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

Authorized official

Name
Mr. Todd Bailey, MBA, CMPE
Title
Executive Director
Phone
(801) 429-2000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1680 W Highway 40
Suite 201
Vernal, UT 84078-4135

Mailing address

589 S State St Ste 201
Provo, UT 84606-5056
Phone (801) 429-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050712000914 UT Part B Supplier - Clinic/Group Practice 6305872201 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Provo, UT; Vernal, UT; Payson, UT
O20140421001798 UT Part A Provider - Federally Qualified Health Center (FQHC) 6305872201 Practice locations: Vernal, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801226907. Details of each certification follow.

Federally qualified health center certification: CCN 461839

Legal name
MOUNTAINLANDS COMMUNITY HEALTH CENTER INC
Doing business as
MOUNTAINLANDS HEALTH CENTER-VERNAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 11, 2014
Last certification
Apr 11, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 19, 1992 in UT
Enrollment address
1680 W Highway 40 Ste 201
Vernal, UT 84078-4135

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

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
46D2109430Mountainlands Family Health Center Vernal1680 West Highway 40 Suite 201, Vernal, UT 84078Certificate of waiverFeb 24, 2028

National Provider Directory

National Provider Directory
Tax ID family
Mountainlands Family Pharmacy - Wasatch12 organizations share this tax ID, including this one
Part of
Mountainlands Family Pharmacy - Wasatch

Other organizations with this tax ID 11

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

Locations

589 S State St
Ste 201
Provo, UT 84606

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Lance Merrell Individual Corporate Director Nov 17, 2021
Logan Gillette Individual Corporate Director Jan 6, 2022
Kimberly Gonzalez Individual Corporate Director Oct 15, 2021
Adriana Chaua Individual Corporate Director Nov 24, 2020
Daniel Tventen Individual Corporate Director Dec 14, 2021
Monica Villarreal Individual Corporate Director Jun 9, 2020
Kirk Benge Individual Corporate Director Mar 5, 2021
Eric Edwards Individual Corporate Director Jan 6, 2022
Ralph Clegg Individual Corporate Director Jan 4, 2022
Charles Stubbs Individual Corporate Director Jun 1, 2020
Eric Johnson Individual Corporate OfficerFinancial Director Jan 1, 2010
W-2 Managing EmployeeFinancial Director Jan 1, 2010
Todd Bailey Individual Corporate OfficerExecutive Director Dec 15, 2009
W-2 Managing EmployeeExecutive Director Dec 15, 2009

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743033600000",
    "number": "1801226907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "589 S STATE ST STE 201",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846065056",
            "telephone_number": "801-429-2000",
            "fax_number": "018-429-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1680 W HIGHWAY 40",
            "address_2": "SUITE 201",
            "city": "VERNAL",
            "state": "UT",
            "postal_code": "840784135",
            "telephone_number": "801-429-2000",
            "fax_number": "801-429-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAINLANDS COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOUNTAINLANDS COMMUNITY HEALTH CENTER",
        "enumeration_date": "2013-11-26",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-429-2000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA, CMPE"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vernal, UT

Sources for this page

Verify at the official NPI Registry.