NPIMap

Organization Active NPI

Glenns Ferry Health Center, Inc.

Doing business as Desert Sage Health Centers

  • Federally Qualified Health Center (FQHC)
  • Grand View, ID
National Provider Identifier
1972633949
Registry record updated Sep 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GLENNS FERRY HEALTH CENTER, INC.
Doing business as
Desert Sage Health Centers
Practice address
350 Main St.
Grand View, ID 83624
Phone
(208) 834-2929
Fax
(208) 587-3324
NPI assigned
Mar 7, 2007
Last updated
Sep 20, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GLENNS FERRY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 20, 2024

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

Authorized official

Name
Sharlet Wilson
Title
Executive Assistant
Phone
(208) 696-7203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X ID Primary

Addresses

Primary practice location

350 Main St.
Grand View, ID 83624

Mailing address

120 Desert Sage Way
Mountain Home, ID 83647-1038
Phone (208) 587-3988

Other identifiers 3

IdentifierTypeStateIssuer
002550600MedicaidID
86645OtherIDBLUE CROSS OF IDAHO
CP8711OtherIDMEDICARE RAILROAD

Other names 1

  • Desert Sage Health Centers Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040119000307 ID Part B Supplier - Clinic/Group Practice 5496656894 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glenns Ferry, ID; Grand View, ID; Mountain Home, ID
O20080605000685 ID Part A Provider - Federally Qualified Health Center (FQHC) 5496656894 Practice locations: Grand View, ID

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972633949. Details of each certification follow.

Federally qualified health center certification: CCN 131806

Legal name
GLENNS FERRY HEALTH CENTER INC
Doing business as
DESERT SAGE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1982 in ID
Enrollment address
350 Main St
Grand View, ID 83624

Other NPIs with the same Medicare PAC ID 3

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.

National Provider Directory

National Provider Directory
Part of
Glenns Ferry Health Ctr

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Maricela Mesilas Individual Corporate Director Oct 1, 2013
Paul Shrum Individual Corporate DirectorTreasurer Feb 15, 2011
Sandy Cantrell Individual Corporate DirectorBoard of Directors Dec 1, 2015
Maria Morales Individual Corporate Director Nov 1, 2017
Darla Rhodes Individual Corporate DirectorVice President Aug 1, 2015
Amber Jordan Individual Corporate OfficerCeo Jul 31, 2024
Operational/Managerial ControlCeo Jul 31, 2024

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1972633949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 DESERT SAGE WAY",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "836471038",
            "telephone_number": "208-587-3988",
            "fax_number": "208-587-3324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 MAIN ST.",
            "city": "GRAND VIEW",
            "state": "ID",
            "postal_code": "83624",
            "telephone_number": "208-834-2929",
            "fax_number": "208-587-3324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENNS FERRY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GLENNS FERRY HEALTH CENTER, INC.",
        "enumeration_date": "2007-03-07",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "SHARLET",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "208-696-7203"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002550600",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "86645",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CP8711",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desert Sage Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand View, ID

Sources for this page

Verify at the official NPI Registry.