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Upper Valley Community Health Services Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Saint Anthony, ID

NPI 1972792489 · NPPES record last updated May 2, 2024

Key facts

NPI
1972792489
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
UPPER VALLEY COMMUNITY HEALTH SERVICES INC
Practice address
335 E Main St Ste 1
Saint Anthony, ID 83445-1546
Phone
(208) 356-4900
Fax
(208) 624-4116
NPI assigned
Oct 20, 2007
Organization subpart
No

Authorized official

Name
Lori K Sessions
Title
Ceo
Phone
(208) 624-4100

Owners & managing parties with NPI records 7

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

Owned or controlled facilities with NPI records 5

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

Other NPIs on the same Medicare enrollment 6

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

Other NPIs with the same Medicare PAC ID 5

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

Facilities with the same owner 4

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

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 34

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in ID

Federally qualified health center certification: CCN 131836

Legal name
UPPER VALLEY COMMUNITY HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 19, 2008
Last certification
Mar 19, 2008
Ownership / control type
For profit – partnership
Organization structure
Corporation · Non-profit
Incorporated
Nov 1, 2007 in ID
Enrollment address
335 E Main St
Ste 1
Saint Anthony, ID 83445-1546

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
Trevor Larson
Individual 		Corporate Director
Board Member		 Nov 27, 2023
Richard Law
Individual 		Corporate Director
Board Member		 Sep 1, 2010
Aimee Zimmer
Individual 		Corporate Officer
Chief Operations Officer		 Jul 23, 2014 33%
Upper Valley Community Health Services Inc
Organization · Saint Anthony, ID
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Nov 1, 2007 100%
Letha Whitmore
Individual 		Corporate Director
Board Member		 Jan 20, 2010
Brad Bybee
Individual 		Corporate Director
Board Member		 Aug 26, 2019
Bernardo Blanco
Individual 		Corporate Director
Board Member		 Oct 24, 2022
Cristine a Walters
Individual 		Corporate Director
Board Member		 Oct 26, 2020
Jacob K Curtis
Individual 		Corporate Director
Medical Director		 Jun 1, 2016
Kristy Parkinson
Individual 		W-2 Managing Employee
Billing Manager		 Mar 26, 2015
Brand Hathaway
Individual 		Corporate Officer
Chief Financial Officer		 Aug 13, 2018 33%
Lori Sessions
Individual 		Corporate Officer
Ceo		 Jun 14, 2018 33%
Genavieve Kirkham
Individual 		Corporate Director
Board Member		 Aug 26, 2019
Dustin Parkinson
Individual 		Corporate Director
Board Member		 Aug 27, 2018
Randy Rose
Individual 		Corporate Director
Board Member		 Mar 26, 2012
Kerry C Williams
Individual 		Corporate Director
Board Member		 Oct 24, 2022

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Grand Peaks Medical Or Grand Peaks Behavioral Health
Rexburg, ID · CCN 131868		 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Feb 8, 2008
Feb 8, 2008
Grand Peaks Behavioral Health
Saint Anthony, ID · CCN 131878		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 4, 2024
Upper Valley Community Health Services Inc
Idaho Falls, ID · CCN 131044		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2024
Grand Peaks Medical Behavioral Health
Dubois, ID · CCN 131051		 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Nov 1, 2007

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20080117000024 ID Part a Provider - Federally Qualified Health Center (FQHC) 4385725282 Practice locations: Saint Anthony, ID
O20120611000120 ID Part B Supplier - Clinic/Group Practice 4385725282 Receives reassigned benefits from 33 practitioners
7 other NPIs on this enrollment
Practice locations: Saint Anthony, ID; Rexburg, ID; Idaho Falls, ID; Dubois, ID

National Provider Directory

Locations

20 N 3rd E
Saint Anthony, ID 83445
Phone (208) 624-4100

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

335 E Main St Ste 1
Saint Anthony, ID 83445-1546

Mailing address

PO Box 18
Saint Anthony, ID 83445-0018
Phone (208) 356-4900

Other names

  • Grand Peaks Medical Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 2, 2024.

{
    "created_epoch": "1192838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714608000000",
    "number": "1972792489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834450018",
            "telephone_number": "208-356-4900",
            "fax_number": "208-624-4112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 E MAIN ST STE 1",
            "city": "SAINT ANTHONY",
            "state": "ID",
            "postal_code": "834451546",
            "telephone_number": "208-356-4900",
            "fax_number": "208-624-4116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPPER VALLEY COMMUNITY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-20",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A",
        "authorized_official_last_name": "SESSIONS",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-624-4100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Peaks Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Anthony, ID

All providers in Saint Anthony, ID · Federally Qualified Health Center (FQHC) in Idaho

Sources for this page

Verify at the official NPI Registry.