NPIMap

Organization Active NPI

Community Hospital of Anaconda

  • Pediatric Adolescent Medicine Physician
  • Anaconda, MT
National Provider Identifier
1992838288
Registry record updated Sep 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
COMMUNITY HOSPITAL OF ANACONDA
Practice address
305 W Pennsylvania Ave
Anaconda, MT 59711-1900
Phone
(406) 563-7337
Fax
(406) 563-8338
NPI assigned
Mar 14, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2015

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

Authorized official

Name
Mrs. Alice R Cortright
Title
Dept Director
Phone
(406) 563-8528

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

305 W Pennsylvania Ave
Anaconda, MT 59711-1900

Mailing address

401 W Pennsylvania St
Anaconda, MT 59711-1931
Phone (406) 563-8528

Other identifiers 1

IdentifierTypeStateIssuer
10442OtherMTSTATE LICENSE

Other names 1

  • anaconda pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030507000045 MT Part A Provider - Critical Access Hospital 8123938974 Receives reassigned benefits from 106 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anaconda, MT
O20031119000745 MT Part B Supplier - Clinic/Group Practice 8123938974 Receives reassigned benefits from 85 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anaconda, MT; Philipsburg, MT; Butte, MT

Hospital certification: CCN 271335

Legal name
COMMUNITY HOSPITAL OF ANACONDA
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2003
Last certification
Jul 20, 2023
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Mar 13, 1969 in MT
Enrollment address
401 W Pennsylvania Ave
Anaconda, MT 59711-1931
Main/Primary Hospital Location

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Community Hospital of AnacondaCCN 271335
Overall star rating
5 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
27D1064682Anaconda Pediatrics305 W Pennsylvania, Anaconda, MT 59711Certificate of waiverFeb 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hospital Crna Dept18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Tricia H Wagner Individual W-2 Managing EmployeeDirector Jan 1, 2022
Audrey J Aspholm Individual Corporate DirectorBoard Member Jan 1, 2018
Freddy J Bartoletti Individual Corporate DirectorDirector Sep 1, 2016
Lee Ann Bartoletti Individual Corporate DirectorBoard Member Jan 1, 2005
Christine M Connors Individual Corporate DirectorBoard Member Jan 1, 2018
Kristy R McKay Individual Corporate DirectorBoard Member Jan 1, 2018
Stephanie J Denham Individual Corporate OfficerCfo Jan 1, 2023
Kira Ann Conn Individual Corporate DirectorDirector Jan 1, 2023
Stan L Blaz Individual Corporate DirectorBoard Member Sep 1, 1999
Margaret I Hickey Boynton Individual Corporate OfficerCeo Mar 1, 2005
William P Finnegan Individual Corporate DirectorBoard Member Apr 1, 2022
Jamie L Johnson Individual Corporate Officer Dec 1, 2005
Erik Swanson Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 33

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

View all 33

Affiliated clinicians 120

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

View all 120

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441065600000",
    "number": "1992838288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 W PENNSYLVANIA ST",
            "city": "ANACONDA",
            "state": "MT",
            "postal_code": "597111931",
            "telephone_number": "406-563-8528",
            "fax_number": "406-563-8565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W PENNSYLVANIA AVE",
            "city": "ANACONDA",
            "state": "MT",
            "postal_code": "597111900",
            "telephone_number": "406-563-7337",
            "fax_number": "406-563-8338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HOSPITAL OF ANACONDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2015-09-01",
        "status": "A",
        "authorized_official_last_name": "CORTRIGHT",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DEPT DIRECTOR",
        "authorized_official_telephone_number": "406-563-8528",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "10442",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "anaconda pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anaconda, MT

Sources for this page

Verify at the official NPI Registry.