NPIMap

Organization Active NPI

Central Valley Medical Center

Doing business as Nephi Medical Clinic

  • Family Medicine Physician
  • Nephi, UT
National Provider Identifier
1992724975
Registry record updated Jun 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CENTRAL VALLEY MEDICAL CENTER
Doing business as
Nephi Medical Clinic
Practice address
48 W 1500 N
Nephi, UT 84648-8900
Phone
(435) 623-3000
Fax
(435) 623-3145
NPI assigned
Jul 19, 2006
Last updated
Jun 8, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2017

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

Authorized official

Name
Brent Davis
Title
Cfo
Phone
(435) 623-3000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

48 W 1500 N
Nephi, UT 84648-8900

Mailing address

48 W 1500 N
PO Box 120
Nephi, UT 84648-8900
Phone (435) 623-3000

Other names 1

  • Nephi Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040419000626 UT Part B Supplier - Clinic/Group Practice 2668380460 Receives reassigned benefits from 34 practitioners
Practice locations: Nephi, UT
O20061104000178 UT Part A Provider - Critical Access Hospital 2668380460 Receives reassigned benefits from 27 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Nephi, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992724975. Details of each certification follow.

Hospital certification: CCN 461304

Legal name
CENTRAL VALLEY MEDICAL CENTER
Doing business as
CENTRAL VALLEY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 10, 2004
Last certification
Nov 7, 2019
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 15, 1984 in UT
Enrollment address
48 W 1500 N
Nephi, UT 84648-8900
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Central Valley Medical Center - CahCCN 461304 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Brian Kartchner7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

152 W 1500 N
Ste A
Nephi, UT 84648
Phone (435) 623-3060

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Central Valley Medical Center Organization, Nephi, UT Non-profit Operational/Managerial Control Jan 1, 1985
Mark R. Stoddard Individual Contracted Managing EmployeeCeo Jan 1, 1985
Corporate OfficerCeo Jan 1, 1985
Alan Kenison Individual Corporate DirectorChairman Dec 8, 2010
Wendell Brent Davis Individual Contracted Managing EmployeeCfo Aug 26, 2003
Corporate OfficerCfo Aug 26, 2003
Mark Chase Individual Corporate DirectorBoard Member Dec 8, 2010
OtherBoard Member Dec 8, 2010

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Central Valley Medical CenterNephi, UT, CCN 461304 Hospital Operational/Managerial Control Jan 1, 1985
Central Valley HospiceNephi, UT, CCN 461526 Hospice 5% Or Greater Direct Ownership Interest Feb 21, 2003

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 39

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 39

Affiliated clinicians 68

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 68

NPI Registry JSON

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496880000000",
    "number": "1992724975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 W 1500 N",
            "address_2": "PO BOX 120",
            "city": "NEPHI",
            "state": "UT",
            "postal_code": "846488900",
            "telephone_number": "435-623-3000",
            "fax_number": "435-623-3145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 W 1500 N",
            "city": "NEPHI",
            "state": "UT",
            "postal_code": "846488900",
            "telephone_number": "435-623-3000",
            "fax_number": "435-623-3145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VALLEY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2017-06-08",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-623-3000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nephi Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nephi, UT

Sources for this page

Verify at the official NPI Registry.