NPIMap

Organization Active NPI

Boulder City Hospital Inc

  • Critical Access Hospital
  • Boulder City, NV
National Provider Identifier
1881739613
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
633HOS11 Issued in NV
Legal business name
BOULDER CITY HOSPITAL INC
Practice address
901 Adams Blvd
Boulder City, NV 89005-2213
Phone
(702) 293-4111
Fax
(702) 294-5732
NPI assigned
Feb 20, 2007
Last updated
Nov 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

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

Authorized official

Name
Frezewed Belete
Title
Controller
Phone
(702) 293-4111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 633HOS11 NV Primary

Addresses

Primary practice location

901 Adams Blvd
Boulder City, NV 89005-2213

Mailing address

901 Adams Blvd
Boulder City, NV 89005-2213
Phone (702) 293-4111

Other identifiers 6

IdentifierTypeStateIssuer
001002839MedicaidNV
001902839MedicaidNV
001102839MedicaidNV
001202839MedicaidNV
002802839MedicaidNV
100502787MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050117000484 NV Part A Provider - Critical Access Hospital 7618953795 Receives reassigned benefits from 2 practitioners
Practice locations: Boulder City, NV
O20180205001368 NV Part B Supplier - Clinic/Group Practice 7618953795 Receives reassigned benefits from 9 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Boulder City, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881739613. Details of each certification follow.

Hospital certification: CCN 291309

Legal name
BOULDER CITY HOSPITAL INC
Doing business as
BOULDER CITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 1, 2005
Last certification
Jun 20, 2025
Beds
67 (20 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 15, 1954 in NV
Enrollment address
901 Adams Blvd.
Boulder City, NV 89005-2213
Other Hospital Practice Location

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 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Boulder City HospitalCCN 291309 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Frezewed Belete Individual W-2 Managing EmployeeController Oct 15, 2013
Bret Runion Individual Corporate DirectorPresident Jan 20, 2022
Scott Hinson Individual Corporate DirectorBoard Member May 16, 2023
Barbara Murphy-Framke Individual Corporate DirectorBoard Member Mar 1, 2024
Cynthia Anderson Individual Corporate DirectorBoard Member Jun 1, 2023
Thomas Maher Individual 5% Or Greater Direct Ownership InterestCeo Apr 16, 2007 100%
Corporate OfficerCeo Apr 16, 2007 100%
W-2 Managing EmployeeCeo Apr 16, 2007 100%
Sunanda Tripathi Manteris Individual Corporate DirectorVice President Jan 20, 2020
Douglas Lewis Individual Corporate OfficerCfo Jan 1, 2015
W-2 Managing EmployeeCfo Jan 1, 2015
Jennifer Zischke Individual Corporate DirectorTreasurer Feb 1, 2023

Practitioners & affiliated clinicians

Practitioners 7

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.

Affiliated clinicians 81

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

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321833600000",
    "number": "1881739613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 ADAMS BLVD",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890052213",
            "telephone_number": "702-293-4111",
            "fax_number": "702-294-5732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 ADAMS BLVD",
            "city": "BOULDER CITY",
            "state": "NV",
            "postal_code": "890052213",
            "telephone_number": "702-293-4111",
            "fax_number": "702-294-5732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER CITY HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2011-11-21",
        "status": "A",
        "authorized_official_last_name": "BELETE",
        "authorized_official_first_name": "FREZEWED",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "702-293-4111"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NV",
            "license": "633HOS11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001002839",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001902839",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001102839",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001202839",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002802839",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100502787",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder City, NV

Sources for this page

Verify at the official NPI Registry.