NPIMap

Organization Active NPI

Milford Memorial Hospital

Doing business as Monument Healthcare Bountiful

  • Skilled Nursing Facility
  • Bountiful, UT
National Provider Identifier
1841058641
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MILFORD MEMORIAL HOSPITAL
Doing business as
Monument Healthcare Bountiful
Practice address
460 W 2600 S
Bountiful, UT 84010-7716
Phone
(949) 687-0233
NPI assigned
Mar 7, 2024
Last updated
May 23, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Authorized official

Name
Tyler Moss
Title
Cfo
Phone
(435) 438-7209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

460 W 2600 S
Bountiful, UT 84010-7716

Mailing address

PO Box 640
Milford, UT 84751-0640
Phone (435) 387-2411

Other identifiers 1

IdentifierTypeStateIssuer
2024-NCF-F23-106736OtherUTLICENSURE

Other names 1

  • Monument Healthcare Bountiful Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240426001759 TN Part A Provider - Skilled Nursing Facility 8426955055 Practice locations: Bountiful, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841058641. Details of each certification follow.

Skilled nursing facility certification: CCN 465112

Legal name
MILFORD MEMORIAL HOSPITAL
Doing business as
MONUMENT HEALTHCARE BOUNTIFUL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 4, 1987
Last certification
Dec 18, 2024
Beds
100
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Monument Health Group
Most recent change of ownership
Feb 1, 2024
Organization structure
GovernmentNon-profit
Incorporated
Jul 2, 1982 in UT
Enrollment address
460 W 2600 S
Bountiful, UT 84010-7716
Nursing home name
MONUMENT HEALTHCARE BOUNTIFUL
Affiliated entity
MONUMENT HEALTH GROUP

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Monument Healthcare BountifulCCN 465112 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 4, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10070.8 residents per day on average
Chain
Monument Health Group11 facilities in the chain
Penalties (3 years)
4Fines totaling $51,852

Processed by Care Compare on Aug 1, 2026.

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
46D0704635Monument Healthcare Bountiful460 West 2600 South, Bountiful, UT 84010Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Milford Valley Health6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Tyler M Nixon Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Christian R West Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Kayla Olney Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Braden Sims Individual Operational/Managerial Control Jun 16, 2026
Adp of the SNF Jun 16, 2026
Spencer R Samuelian Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Monument Health Group LLC Organization, Laguna Beach, CA LLC, Management services company Operational/Managerial Control Feb 1, 2024
Adp of the SNF Mar 5, 2025
Monument Health Properties LLC Organization, Laguna Beach, CA Created for acquisition, LLC 5% Or Greater Mortgage Interest Feb 1, 2024 100%
Adp of the SNF Feb 1, 2024
Stephen Blake Marriott Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Jason J Seastrand Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Milford Memorial Hospital Organization, Milford, UT 5% Or Greater Direct Ownership Interest Feb 1, 2024 100%
Operational/Managerial Control Feb 1, 2024
Adp of the SNF Mar 6, 2025
Direct Ownership Interest Feb 1, 2024 100%
Lindsay Fragoso Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Monument Health Bountiful LLC Organization, Laguna Beach, CA Created for acquisition, LLC, Owned by another organization or individual 5% Or Greater Mortgage Interest Feb 7, 2025 100%
Adp of the SNF Feb 1, 2024
Brett P Robertson Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Tyler Moss Individual Corporate OfficerChief Finance Officer Feb 1, 2024
Travis Clawson Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Health Group Management LLC Organization, Laguna Beach, CA LLC, Management services company Operational/Managerial Control Feb 1, 2024
Adp of the SNF Jan 31, 2025

Owners & managing parties with NPI records 5

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

  • Milford Memorial Hospital

    dba Sunshine Terrace Skilled Nursing

    • Skilled Nursing Facility
    • Logan, UT
    • NPI 1063194876

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Milford Memorial Hospital
    • Critical Access Hospital
    • Milford, UT
    • NPI 1427064211

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Milford Memorial Hospital

    dba Midtown Manor

    • Skilled Nursing Facility
    • Salt Lake City, UT
    • NPI 1487498978

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Milford Memorial Hospital

    dba Monument Healthcare Millcreek

    • Skilled Nursing Facility
    • Salt Lake City, UT
    • NPI 1699533497

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Tyler Mark Nixon, DO
    • Internal Medicine Physician
    • Layton, UT
    • NPI 1669639985

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Milford Memorial HospitalLogan, UT, CCN 465079 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Oct 2, 2022

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 31

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

View all 31

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": "1709769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747958400000",
    "number": "1841058641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "MILFORD",
            "state": "UT",
            "postal_code": "847510640",
            "telephone_number": "435-387-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 W 2600 S",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840107716",
            "telephone_number": "949-687-0233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILFORD MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-07",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-438-7209"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSURE",
            "identifier": "2024-NCF-F23-106736",
            "state": "UT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Monument Healthcare Bountiful",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monument Healthcare Bountiful",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bountiful, UT

Sources for this page

Verify at the official NPI Registry.