Confederated Tribes of the Goshute Reservation
Organization Active NPI Clinic/Center · Salt Lake City, UT
NPI 1992141964 · NPPES record last updated Dec 11, 2025
Key facts
- NPI
- 1992141964
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
- Practice address
- 660 S 200 E
Suite 250
Salt Lake City, UT 84111-3835 - Phone
- (801) 359-2256
- NPI assigned
- May 17, 2013
- Organization subpart
- Yes
- Parent organization (as reported)
- CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
Authorized official
- Name
- Linda Thatcher
- Title
- Billing
- Phone
- (801) 359-2256
Other NPIs on the same Medicare enrollment 1
Practitioners 39
-
Leon Harvey Butler, PHD
-
Keith J. Castleton, O.D.
-
John B Dame, MD
-
Haven Ann Lewis Halk, A.P.R.N
-
Daniel Hansen, D.P.M.
-
Arlene R Holland, APRN
-
Lanae Kimber, CMHC
-
Megan Kimberly, DNP
-
Denise Larocca, OTD, MS, OTR/L, MS
-
Kate Lillie, PA-C
-
Gina Marie Makouske, CSW
-
Katherine Ramsey May, DPT
-
Carissa S Monroy, MD
-
Elizabeth Neilson, DPT
-
Callan L. Parra, MD
-
Danielle Renee Puri, ARNP
-
Amber Trishell Rasmussen, PA-C
-
Jacqueline F Reed, CSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, UT
Federally qualified health center certification: CCN 461840
- Legal name
- CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION
- Doing business as
- SACRED CIRCLE HEALTH CARE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 17, 2014
- Last certification
- Jun 17, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Proprietary
- Incorporated
- Nov 26, 1940 in UT
- Enrollment address
- 660 South 200 East
Suite 250
Salt Lake, UT 84111-3846
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Hope Jackson |
Corporate Director |
Apr 1, 2018 | |
| Matthew Judd |
Corporate Director |
Apr 1, 2018 | 100% |
| Operational/Managerial Control |
May 1, 2018 | ||
| Mary Pete-Freeman |
Corporate Director |
Dec 1, 2018 | |
| Lorena Horse |
Operational/Managerial Control |
Apr 4, 2018 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130724000653 | TX | Part B Supplier - Clinic/Group Practice | 0042451650 |
Receives reassigned benefits from 80 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Salt Lake City, UT; West Valley City, UT; Ibapah, UT |
| O20140618000896 | UT | Part a Provider - Federally Qualified Health Center (FQHC) | 0042451650 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Salt Lake, UT |
National Provider Directory
- Part of
- Confederated Tribes of the Goshute Indian Reservation
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
660 S 200 E
Suite 250
Salt Lake City, UT 84111-3835
Mailing address
660 S 200 E
Suite 250
Salt Lake City, UT 84111-3835
Phone (801) 359-2256
Other names
- Sacred Circle Healthcare
Other providers in Salt Lake City, UT
- Confederated Tribes of the Goshute Reservation
- Confederated Tribes of the Goshute Reservation
- Confederated Tribes of the Goshute Reservation
- Confederated Tribes of the Goshute Reservation
- Confederated Tribes of the Goshute Reservation
- Confluence Counseling PLLC
- Elizabeth A. Congdon
- Aaron Marcus Conger
- Theodore L. Conger
- Conklin Eyecare PLLC.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.