NPIMap

Organization Active NPI

Mountain Family Health Centers

Doing business as Mountain Family Health Centers Avon

  • Federally Qualified Health Center (FQHC)
  • Avon, CO
National Provider Identifier
1982328969
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAIN FAMILY HEALTH CENTERS
Doing business as
Mountain Family Health Centers Avon
Practice address
230 Chapel SQ Unit D-102
Avon, CO 81620-6497
Phone
(970) 945-2840
Fax
(970) 945-2893
NPI assigned
Oct 3, 2022
Last updated
Oct 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Ross Brooks
Title
Ceo
Phone
(970) 928-1609

Specialties & licenses 1

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

Addresses

Primary practice location

230 Chapel SQ Unit D-102
Avon, CO 81620-6497

Mailing address

PO Box 339
Glenwood Springs, CO 81602-0339
Phone (970) 928-1635

Other names 1

  • Mountain Family Health Centers Avon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040316000175 CO Part B Supplier - Clinic/Group Practice 3173413101 Receives reassigned benefits from 32 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gypsum, CO; Rifle, CO; Glenwood Springs, CO; Basalt, CO; Avon, CO
O20230109002982 CO Part A Provider - Federally Qualified Health Center (FQHC) 3173413101 Practice locations: Avon, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982328969. Details of each certification follow.

Federally qualified health center certification: CCN 061046

Legal name
MOUNTAIN FAMILY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 3, 2023
Last certification
Jan 3, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
230 Chapel SQ
Unit D-102
Avon, CO 81620-6497

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Mountain Family Health Centers14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

230 Chapel Sq
#D102
Avon, CO 81620

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
Mountain Family Health Centers Organization, Glenwood Springs, CO Corporation, Non-profit Operational/Managerial Control Jan 3, 2023 100%
Dustin Moyer Individual Corporate OfficerChief Executive Officer Feb 5, 2024 100%
Patricia Kramer Individual Corporate DirectorBoard of Directors Treasurer Sep 27, 2022
Arturo M Fernandez Individual Corporate OfficerChief Operations Officer Jul 23, 2007
Operational/Managerial ControlChief Operations Officer Jul 23, 2007
Sydney Schalit Individual Corporate DirectorBoard of Directors Chair Sep 27, 2022
Betty Lucas Individual Corporate DirectorBoard of Directors Secretary Dec 20, 2022

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1982328969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 339",
            "city": "GLENWOOD SPRINGS",
            "state": "CO",
            "postal_code": "816020339",
            "telephone_number": "970-928-1635",
            "fax_number": "970-945-9581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 CHAPEL SQ UNIT D-102",
            "city": "AVON",
            "state": "CO",
            "postal_code": "816206497",
            "telephone_number": "970-945-2840",
            "fax_number": "970-945-2893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN FAMILY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-09-29",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-928-1609"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Family Health Centers Avon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Avon, CO

Sources for this page

Verify at the official NPI Registry.