NPIMap

Organization Active NPI

Kremmling Memorial Hospital District

Doing business as Middle Park Medical Center

  • Physical Therapy Clinic/Center
  • Fraser, CO
National Provider Identifier
1821647413
Registry record updated Sep 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
KREMMLING MEMORIAL HOSPITAL DISTRICT
Doing business as
Middle Park Medical Center
Practice address
45 County Road 804
Fraser, CO 80442-0000
Phone
(970) 724-3171
Fax
(970) 724-9606
NPI assigned
Sep 6, 2019
Last updated
Sep 26, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
KREMMLING MEMORIAL HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 26, 2022

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

Authorized official

Name
Mikealena Horner
Title
Director of Finance
Phone
(970) 724-3171

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

45 County Road 804
Fraser, CO 80442-0000

Mailing address

PO Box 399
Kremmling, CO 80459-0399
Phone (970) 724-3171

Other identifiers 1

IdentifierTypeStateIssuer
9000141155MedicaidCO

Other names 1

  • Middle Park Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061104000225 CO Part A Provider - Critical Access Hospital 7517871544 5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kremmling, CO; Granby, CO; Fraser, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821647413. Details of each certification follow.

Hospital certification: CCN 061318

Legal name
KREMMLING MEMORIAL HOSPITAL DISTRICT
Doing business as
MIDDLE PARK MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 1, 2003
Last certification
Jun 5, 2023
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Incorporated
Apr 1, 2003 in CO
Enrollment address
214 South 4TH St.
Middle Park Medical Center, Kremmling
Kremmling, CO 80459-0399
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Middle Park Medical CenterCCN 061318 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
James H Asthalter DO17 organizations share this tax ID, including this one
Part of
James H Asthalter DO

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Mikealena S Horner Individual W-2 Managing Employee Oct 18, 2010
Jason Cleckler Individual Corporate OfficerCeo Jan 13, 2020 50%
Kremmling Memorial Hospital District Organization, Kremmling, CO Operational/Managerial Control Mar 1, 2003

Owners & managing parties with NPI records 6

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

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

Affiliated clinicians 116

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

View all 116

NPI Registry JSON

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

{
    "created_epoch": "1567728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664150400000",
    "number": "1821647413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 399",
            "city": "KREMMLING",
            "state": "CO",
            "postal_code": "804590399",
            "telephone_number": "970-724-3171",
            "fax_number": "970-724-9606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 COUNTY ROAD 804",
            "city": "FRASER",
            "state": "CO",
            "postal_code": "804420000",
            "telephone_number": "970-724-3171",
            "fax_number": "970-724-9606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KREMMLING MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KREMMLING MEMORIAL HOSPITAL DISTRICT",
        "enumeration_date": "2019-09-06",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "HORNER",
        "authorized_official_first_name": "MIKEALENA",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "970-724-3171"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000141155",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Middle Park Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fraser, CO

Sources for this page

Verify at the official NPI Registry.