NPIMap

Organization Active NPI

Boundary Community Hospital

  • Rural Health Clinic/Center
  • Bonners Ferry, ID
National Provider Identifier
1801273552
Registry record updated Jun 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
43 Issued in ID
Legal business name
BOUNDARY COMMUNITY HOSPITAL
Practice address
6641 Kaniksu St
Bonners Ferry, ID 83805-7532
Phone
(208) 267-3655
Fax
(208) 267-3757
NPI assigned
May 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2022

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

Authorized official

Name
April D Bennett
Title
Ceo
Phone
(208) 267-4850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 43 ID Primary

Addresses

Primary practice location

6641 Kaniksu St
Bonners Ferry, ID 83805-7532

Mailing address

6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Phone (208) 267-3141

Other identifiers 1

IdentifierTypeStateIssuer
1801273552MedicaidID

Other names 1

  • Boundary Community Clinics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140129001414 ID Part A Provider - Rural Health Clinic 3274583406 1 other NPI on this enrollment
Practice locations: Bonners Ferry, ID

Rural health clinic certification: CCN 138521

Legal name
BOUNDARY COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 20, 2014
Last certification
Oct 20, 2014
Ownership / control type
2A
Organization structure
OtherNon-profit
Enrollment address
6641 Kaniksu St
Bonners Ferry, ID 83805-7532
Related CCNs
131301

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

Other NPIs with the same Medicare PAC ID 3

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
13D0998799Boundary Community Clinics6641 Kaniksu St #a, Bonners Ferry, ID 83805Certificate of waiverFeb 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Boundary Community Hospital5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

100 E Warm Springs Ave
Boise, ID 83712
Phone (208) 331-7064

6641 Kaniksu St
#A
Bonners Ferry, ID 83805
Phone (208) 265-3655

2108 W 7th St
Ste A
Brooklyn, NY 11223

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Elden Koon Individual Corporate DirectorBoard Member Jan 1, 2014
Boundary Community Hospital Organization, Bonners Ferry, ID Operational/Managerial Control Jan 1, 2014 100%
Paul Hazdovac Individual Corporate DirectorBoard Member Jan 1, 2014
April D Bennett Individual Corporate Officer Jun 6, 2022
W-2 Managing EmployeeCeo Jun 6, 2022
Melinda B Smithson Individual W-2 Managing Employee Feb 21, 2022

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Boundary Community HospitalBonners Ferry, ID, CCN 131301 Hospital Operational/Managerial Control Oct 4, 2007
Boundary Community HospitalBonners Ferry, ID, CCN 13Z301 Hospital Operational/Managerial Control Oct 4, 2007
Boundary County Nursing HomeBonners Ferry, ID, CCN 135004 Skilled nursing facility Operational/Managerial Control
Trustee of the SNF
Adp of the SNF		 Jan 1, 1966
Jan 1, 1966
Dec 4, 2024

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 79

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

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1430438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656374400000",
    "number": "1801273552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6640 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-3141",
            "fax_number": "208-267-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6641 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-3655",
            "fax_number": "208-267-3757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUNDARY COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-01",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-267-4850"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "ID",
            "license": "43",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1801273552",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boundary Community Clinics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Boundary Community Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonners Ferry, ID

Sources for this page

Verify at the official NPI Registry.