NPIMap

Organization Active NPI

Southern Mono Health Care District

Doing business as Mammoth Hospital

  • Critical Access Hospital Clinic/Center
  • Mammoth Lakes, CA
National Provider Identifier
1962444059
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access Hospital Clinic/CenterTaxonomy code 261QC0050X
License
240000008 Issued in CA
Legal business name
SOUTHERN MONO HEALTH CARE DISTRICT
Doing business as
Mammoth Hospital
Practice address
85 Sierra Park Rd
Mammoth Lakes, CA 93546-2073
Phone
(760) 934-3311
Fax
(760) 924-4149
NPI assigned
Jun 12, 2006
Last updated
Feb 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Authorized official

Name
Mrs. Melanie Van Winkle
Title
Chief Financial Officer
Phone
(760) 934-3311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital Clinic/Center 261QC0050X 240000008 CA Primary

Addresses

Primary practice location

85 Sierra Park Rd
Mammoth Lakes, CA 93546-2073

Mailing address

PO Box 660
85 Sierra Park Rd.
Mammoth Lakes, CA 93546
Phone (760) 934-3311

Other identifiers 4

IdentifierTypeStateIssuer
HAP18523FMedicaidCA
RHM18523FMedicaidCA
HSP30638HMedicaidCA
HSP40638HMedicaidCA

Other names 1

  • Mammoth Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address providerenrollment@mammothhospital.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118001160 CA Part B Supplier - Clinic/Group Practice 9830002401 Receives reassigned benefits from 122 practitioners
1 other NPI on this enrollment
Practice locations: Mammoth Lakes, CA
O20100915000147 CA Part A Provider - Critical Access Hospital 9830002401 Receives reassigned benefits from 90 practitioners
Practice locations: Mammoth Lakes, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962444059. Details of each certification follow.

Hospital certification: CCN 051303

Legal name
SOUTHERN MONO HEALTH CARE DISTRICT
Doing business as
MAMMOTH HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2001
Last certification
Dec 4, 2018
Beds
17
Ownership / control type
Hospital district or authority
Organization structure
OtherNon-profit
Enrollment address
85 Sierra Park Rd
Mammoth Lakes, CA 93546
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 1

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
Mammoth HospitalCCN 051303 · 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

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Melanie Van Winkle Individual Corporate Officer Jan 11, 2010
W-2 Managing EmployeeChief Financial Officer Jan 11, 2010
Southern Mono Health Care District Organization, Mammoth Lakes, CA Operational/Managerial Control Feb 1, 2010

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mammoth HospitalMammoth Lakes, CA, CCN 058523 Rural health clinic Operational/Managerial Control Feb 1, 2010

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 1

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

Practitioners & affiliated clinicians

Practitioners 130

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 130

Affiliated clinicians 78

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

View all 78

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645747200000",
    "number": "1962444059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "address_2": "85 SIERRA PARK RD.",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "93546",
            "telephone_number": "760-934-3311",
            "fax_number": "760-924-4149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SIERRA PARK RD",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935462073",
            "telephone_number": "760-934-3311",
            "fax_number": "760-924-4149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MONO HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A",
        "authorized_official_last_name": "VAN WINKLE",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "760-934-3311",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QC0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Critical Access Hospital",
            "state": "CA",
            "license": "240000008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP18523F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM18523F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP30638H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40638H",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "providerenrollment@mammothhospital.com",
            "affiliation": "N",
            "endpointDescription": "Email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "85 Sierra Park Rd",
            "city": "Mammoth Lakes",
            "state": "CA",
            "country_code": "US",
            "postal_code": "935462073",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mammoth Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mammoth Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mammoth Lakes, CA

Sources for this page

Verify at the official NPI Registry.