NPIMap

Organization Active NPI

Caribou Medical Center, Inc

Doing business as Caribou Medical Center

  • Critical Access Hospital
  • Soda Springs, ID
National Provider Identifier
1942970272
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
CARIBOU MEDICAL CENTER, INC
Doing business as
Caribou Medical Center
Practice address
300 S 3Rd W
Soda Springs, ID 83276-1559
Phone
(208) 547-3341
Fax
(208) 547-2790
NPI assigned
Sep 17, 2021
Last updated
Sep 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

Name
Sheri Henderson
Title
Credentialing Specialist
Phone
(208) 547-0700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

300 S 3Rd W
Soda Springs, ID 83276-1559

Mailing address

300 S 3Rd W
Soda Springs, ID 83276-1559
Phone (208) 547-3341

Other names 1

  • Caribou Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20211021002404 ID Part A Provider - Critical Access Hospital 7618365701 Receives reassigned benefits from 52 practitioners
Practice locations: Soda Springs, ID
O20220314000619 ID Part B Supplier - Clinic/Group Practice 7618365701 Receives reassigned benefits from 61 practitioners
1 other NPI on this enrollment
Practice locations: Soda Springs, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942970272. Details of each certification follow.

Hospital certification: CCN 131309

Legal name
CARIBOU MEDICAL CENTER, INC
Doing business as
CARIBOU MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2000
Last certification
Feb 14, 2017
Beds
25
Ownership / control type
Local
Organization structure
OtherNon-profit
Incorporated
Aug 1, 2021 in ID
Enrollment address
300 S 3Rd W
Soda Springs, ID 83276-1559
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 2

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.

Care Compare: Hospital

Medicare Care Compare
Listed as
Caribou Medical CenterCCN 131309 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Local
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 11

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

NameRoleSinceShare
Wesley Brown Individual Corporate DirectorBoard of Director Aug 1, 2021
Sheri Henderson Individual W-2 Managing EmployeeCredentialing Specialist Aug 1, 2021
Charlene McCulloch Individual Corporate DirectorBoard of Director Sep 27, 2023
Stephanie Rindlisbaker Individual Corporate DirectorBoard of Director Mar 1, 2023
Rachel Capell Individual W-2 Managing EmployeeDirector of Patient Financial Serv Aug 1, 2021
Kristin Horsley Individual W-2 Managing EmployeeCredentialing Dec 14, 2023
Curtis Toone Individual Corporate DirectorBoard of Director Aug 31, 2022
Craig Mansfield Individual Corporate DirectorBoard of Director Aug 1, 2021
Caribou Medical Center, Inc Organization, Soda Springs, ID Created for acquisition, Non-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2021 100%
Kent D Loosle Individual Corporate OfficerCeo Nov 1, 2023
W-2 Managing EmployeeCeo Nov 1, 2023
Lorraine Myers Individual Corporate DirectorBoard of Director Aug 1, 2021

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Caribou Medical Center Swing BedSoda Springs, ID, CCN 13Z309 Hospital Operational/Managerial Control (100%) Aug 1, 2021
Lakeview Medical ClinicSoda Springs, ID, CCN 138506 Rural health clinic Operational/Managerial Control (100%) Aug 1, 2021

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 68

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.

View all 68

Affiliated clinicians 79

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

View all 79

NPI Registry JSON

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

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1942970272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 S 3RD W",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761559",
            "telephone_number": "208-547-3341",
            "fax_number": "208-547-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 3RD W",
            "city": "SODA SPRINGS",
            "state": "ID",
            "postal_code": "832761559",
            "telephone_number": "208-547-3341",
            "fax_number": "208-547-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARIBOU MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-17",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "SHERI",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "208-547-0700"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caribou Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Soda Springs, ID

Sources for this page

Verify at the official NPI Registry.