NPIMap

Organization Active NPI

Uncompahgre Combined Clinics

Doing business as Uncompahgre Medical Center

  • Federally Qualified Health Center (FQHC)
  • Norwood, CO
National Provider Identifier
1982774816
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0096 Issued in CO
Legal business name
UNCOMPAHGRE COMBINED CLINICS
Doing business as
Uncompahgre Medical Center
Practice address
1350 S. Aspen St
Norwood, CO 81423
Phone
(970) 327-4233
Fax
(970) 327-4228
NPI assigned
Nov 8, 2006
Last updated
Mar 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Authorized official

Name
Mr. Scott J Bookman
Title
Executive Director
Phone
(970) 327-0522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0096 CO Primary

Addresses

Primary practice location

1350 S. Aspen St
Norwood, CO 81423

Mailing address

PO Box 280
1350 S. Aspen St
Norwood, CO 81423
Phone (970) 327-4233

Other identifiers 1

IdentifierTypeStateIssuer
05600838MedicaidCO

Other names 1

  • Uncompahgre Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050222000809 CO Part A Provider - Federally Qualified Health Center (FQHC) 2466405162 Practice locations: Norwood, CO
O20100113000818 CO Part B Supplier - Clinic/Group Practice 2466405162 Receives reassigned benefits from 9 practitioners
Practice locations: Norwood, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982774816. Details of each certification follow.

Federally qualified health center certification: CCN 061806

Legal name
UNCOMPAHGRE COMBINED CLINICS
Doing business as
DATA MARSHALL
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 – partnership
Organization structure
OtherNon-profit
Incorporated
Feb 4, 1993 in CO
Enrollment address
1350 S Aspen St
Norwood, CO 81423-0280

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
06D0695002Uncompahgre Medical Center1350 Aspen Street, Norwood, CO 81423Provider-performed microscopySep 5, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Anita Johnson Individual Corporate Director Jan 11, 2014 10%
George Hiddy Individual Corporate DirectorGeneral Board Member Jan 20, 2024
Jesse Dudley Individual Corporate DirectorGeneral Board Member Apr 26, 2023
Andrea B Hill Individual Corporate DirectorGeneral Board Member Feb 5, 2024
Emily S Haight Individual Corporate Director Jan 26, 2017 10%
Charles Porth Individual Corporate OfficerCeo Aug 5, 2020
W-2 Managing EmployeeCeo Aug 5, 2020
Operational/Managerial ControlCeo Aug 5, 2020
Kristin Holstrom Individual Corporate DirectorGeneral Board Member Aug 24, 2022
Bradford Hewitt Individual Corporate DirectorBoard of Directors, Treasurer Mar 26, 2023
Rhonda Oliver Individual Corporate DirectorGeneral Board Member Aug 24, 2022
Patricia L Lippert Individual Operational/Managerial ControlController Aug 1, 2024
David Jones Individual Corporate Director Jan 11, 2014 10%
Andrew Kauffman Individual Corporate Director Apr 28, 2016 10%

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1982774816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280",
            "address_2": "1350 S. ASPEN ST",
            "city": "NORWOOD",
            "state": "CO",
            "postal_code": "81423",
            "telephone_number": "970-327-4233",
            "fax_number": "970-327-4228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 S. ASPEN ST",
            "city": "NORWOOD",
            "state": "CO",
            "postal_code": "81423",
            "telephone_number": "970-327-4233",
            "fax_number": "970-327-4228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNCOMPAHGRE COMBINED CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "BOOKMAN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-327-0522",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": "0096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05600838",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Uncompahgre Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Norwood, CO

Sources for this page

Verify at the official NPI Registry.