NPIMap

Organization Active NPI

San Juan County Hospital

Doing business as San Juan Healthcare Services

  • Medicare Defined Swing Bed Hospital Unit
  • Monticello, UT
National Provider Identifier
1831351816
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
2006-HOSP-203 Issued in UT
Legal business name
SAN JUAN COUNTY HOSPITAL
Doing business as
San Juan Healthcare Services
Practice address
380 W 100 N
Monticello, UT 84535-0308
Phone
(435) 587-2116
Fax
(435) 587-3004
NPI assigned
Jun 30, 2008
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
Mr. Clayton H. Holt
Title
C.E.O.
Phone
(435) 587-2116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 2006-HOSP-203 UT Primary

Addresses

Primary practice location

380 W 100 N
Monticello, UT 84535-0308

Mailing address

PO Box 308
Monticello, UT 84535-0308
Phone (435) 587-2116

Other names 1

  • San Juan Healthcare Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070105000461 UT Part A Provider - Critical Access Hospital 4486541851 1 other NPI on this enrollment
Practice locations: Monticello, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831351816. Details of each certification follow.

Hospital certification: CCN 46Z308

Legal name
SAN JUAN COUNTY HOSPITAL
Organization structure
GovernmentNon-profit
Enrollment address
380 W 100 N
Monticello, UT 84535-0308
Hospital Swing-Bed Unit

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

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
San Juan Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 4

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 Nov 4, 2014 100%
Clayton Holt Individual Corporate OfficerCeo Jul 1, 2014 100%
W-2 Managing EmployeeCeo Jul 1, 2014 100%
Farley Crofts Individual Corporate OfficerCfo Oct 19, 2015
W-2 Managing Employee Oct 19, 2015
Operational/Managerial ControlCfo Oct 19, 2015
Kimberly Degraw Individual W-2 Managing EmployeeBusiness Office Manager Mar 30, 2016

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 Clinic BlandingBlanding, UT, CCN 463989 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 1, 1999
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

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1831351816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "MONTICELLO",
            "state": "UT",
            "postal_code": "845350308",
            "telephone_number": "435-587-2116",
            "fax_number": "435-587-3004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 W 100 N",
            "city": "MONTICELLO",
            "state": "UT",
            "postal_code": "845350308",
            "telephone_number": "435-587-2116",
            "fax_number": "435-587-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUAN COUNTY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "HOLT",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "435-587-2116",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "UT",
            "license": "2006-HOSP-203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Juan Healthcare Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monticello, UT

Sources for this page

Verify at the official NPI Registry.