NPIMap

Organization Active NPI

San Juan County Hospital

Doing business as Blanding Clinic

  • Rural Health Clinic/Center
  • Blanding, UT
National Provider Identifier
1821045840
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAN JUAN COUNTY HOSPITAL
Doing business as
Blanding Clinic
Blanding Medical Clinic
San Juan Clinic-Blanding
Practice address
735 S 200 W
Blanding, UT 84511-3922
Phone
(435) 678-2254
Fax
(435) 678-2534
NPI assigned
May 27, 2006
Last updated
Jul 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Authorized official

Name
Farley Crofts
Title
Cfo
Phone
(435) 587-1116

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X 2005HOSP-203 UT

Addresses

Primary practice location

735 S 200 W
Blanding, UT 84511-3922

Mailing address

735 S 200 W
Blanding, UT 84511-3909
Phone (435) 678-2254

Other identifiers 1

IdentifierTypeStateIssuer
876000309120MedicaidUT

Other names 3

  • Blanding Clinic Doing business as
  • Blanding Medical Clinic Doing business as
  • San Juan Clinic-Blanding Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL tbrooks@sanjuanhealth.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040301000938 UT Part B Supplier - Clinic/Group Practice 4486541851 Receives reassigned benefits from 28 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monticello, UT; Spanish Valley, UT
O20050714000876 UT Part A Provider - Rural Health Clinic 4486541851 Practice locations: Blanding, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821045840. Details of each certification follow.

Rural health clinic certification: CCN 463989

Legal name
SAN JUAN COUNTY HOSPITAL
Doing business as
SAN JUAN CLINIC BLANDING
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 17, 2000
Last certification
May 23, 2017
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
735 S 200 W
Ste 3
Blanding, UT 84511-3909

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 4

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
46D0939679Blanding Medical Clinic735 South 200 West, Suite 3, Blanding, UT 84511Provider-performed microscopyMay 14, 2027

National Provider Directory

National Provider Directory

Locations

735 S 200 W
Blanding, UT 84511
Phone (435) 678-2254

735 S 200 W
Ste 3
Blanding, UT 84511
Phone (435) 678-2254

5555 Old Airport Rd
Moab, UT 84532
Phone (435) 419-9210

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
San Juan County Hospital Organization, Monticello, UT 5% Or Greater Direct Ownership Interest Mar 1, 1999 100%
Teresa Brooks Individual W-2 Managing EmployeeBilling Manager Jan 29, 2024
Operational/Managerial ControlBilling Manager Jan 29, 2024
Clayton Holt Individual Corporate OfficerChief Executive Officer Feb 1, 2015
Melissa Slade Individual W-2 Managing EmployeeCredentialing Specialist Oct 1, 2024
Operational/Managerial ControlCredentialing Specialist Oct 1, 2024
Farley Crofts Individual Corporate OfficerChief Financial Officer Feb 13, 2018
W-2 Managing EmployeeAd; Feb 13, 2018

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
San Juan County HospitalMonticello, UT, CCN 461308 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 4, 2014
San Juan County HospitalMonticello, UT, CCN 46Z308 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 4, 2014
San Juan ClinicMonticello, UT, CCN 463993 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 4, 2014
Spanish Valley ClinicSpanish Valley, UT, CCN 463996 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 1999

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1821045840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "735 S 200 W",
            "city": "BLANDING",
            "state": "UT",
            "postal_code": "845113909",
            "telephone_number": "435-678-2254",
            "fax_number": "435-678-2534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 S 200 W",
            "city": "BLANDING",
            "state": "UT",
            "postal_code": "845113922",
            "telephone_number": "435-678-2254",
            "fax_number": "435-678-2534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "CROFTS",
        "authorized_official_first_name": "FARLEY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-587-1116"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "2005HOSP-203",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "876000309120",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "tbrooks@sanjuanhealth.org",
            "affiliation": "N",
            "endpointDescription": "Email Address",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "735 S 200 W",
            "city": "Blanding",
            "state": "UT",
            "country_code": "US",
            "postal_code": "845113922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Blanding Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blanding Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blanding Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Juan Clinic-Blanding",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blanding, UT

Sources for this page

Verify at the official NPI Registry.