NPIMap

San Juan County Hospital

Organization Active NPI Rural Health Clinic/Center · Blanding, UT

NPI 1821045840 · NPPES record last updated Jul 17, 2024

Key facts

NPI
1821045840
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
SAN JUAN COUNTY HOSPITAL
Practice address
735 S 200 W
Blanding, UT 84511-3922
Phone
(435) 678-2254
Fax
(435) 678-2534
NPI assigned
May 27, 2006
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 4

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

Owned or controlled facilities with NPI records 4

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

Other NPIs on the same Medicare enrollment 4

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

Other NPIs with the same Medicare PAC ID 4

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

Facilities with the same owner 4

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

Practitioners 24

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D0939679Blanding Medical Clinic
735 South 200 West, Suite 3, Blanding, UT 84511		Provider-performed microscopyMay 14, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in UT

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
Other · Non-profit
Enrollment address
735 S 200 W
Ste 3
Blanding, UT 84511-3909

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 Employee
Billing Manager		 Jan 29, 2024
Operational/Managerial Control
Billing Manager		 Jan 29, 2024
Clayton Holt
Individual 		Corporate Officer
Chief Executive Officer		 Feb 1, 2015
Melissa Slade
Individual 		W-2 Managing Employee
Credentialing Specialist		 Oct 1, 2024
Operational/Managerial Control
Credentialing Specialist		 Oct 1, 2024
Farley Crofts
Individual 		Corporate Officer
Chief Financial Officer		 Feb 13, 2018
W-2 Managing Employee
Ad;		 Feb 13, 2018

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

Medicare enrollment records

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

National Provider Directory

Locations

804 N 400 W
Blanding, UT 84511
Phone (435) 259-2508

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X 2005HOSP-203 UT
Rural Health Clinic/Center 261QR1300X Yes

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

IdentifierTypeStateIssuer
876000309120MedicaidUT

Other names

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

Electronic endpoints

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

Other providers in Blanding, UT

All providers in Blanding, UT · Rural Health Clinic/Center in Utah

Sources for this page

Verify at the official NPI Registry.