Sonora Community Hospital
Organization Active NPI Rural Health Clinic/Center · Sonora, CA
NPI 1003014952 · NPPES record last updated Aug 22, 2019
Key facts
- NPI
- 1003014952
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SONORA COMMUNITY HOSPITAL
- Practice address
- 193 Fairview LN
Sonora, CA 95370-4828 - Phone
- (209) 536-5100
- Fax
- (209) 536-5108
- NPI assigned
- Jul 3, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- SONORA COMMUNITY HOSPITAL
Authorized official
- Name
- Gregory D McCulloch
- Title
- Ceo
- Phone
- (209) 536-5011
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 9
Related certifications (CCN) 12
Facilities with the same owner 105
Practitioners 198
-
Loui Abdelghani, M.D
-
Ariana Abid, MD
-
Keren Akakpo, PA-C
-
Harry Balian, M.D.
-
Charles Boadu, MD
-
Angelica Buenrostro, PA-C
-
Alexa Lee Calfee, MD MPH
-
Tamara Ann Chambless, M.D.
-
Cicely Chen, M.D.
-
Josebelo D Chong, MD
-
Julia Dean, FNP
-
Christine Ann Elder, PA-C
-
Mark R Gordon, MD
-
Jennifer Hamblin, MMS, PA-C, ATC
-
Gabriel Herscu, M.D.
-
Manan A Jhaveri, MD
-
Christopher Lee Jones, M.D.
-
Deborah L Kagay, FNP-C, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0934430 | Sonora Community Hospital Dba | Certificate of waiver | Sep 30, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Rural health clinic certification: CCN 053991
- Legal name
- SONORA COMMUNITY HOSPITAL
- Doing business as
- ADVENTIST HEALTH SONORA RHC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Oct 15, 1992
- Last certification
- May 9, 2019
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1984 in CA
- Enrollment address
- 193 Fairview LN
Sonora, CA 95370-4828 - Related CCNs
- 050335
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Kerry L Heinrich |
Corporate Director |
Dec 16, 2014 | |
| Meredith S Jobe |
Corporate Officer |
Mar 31, 2014 | |
| Billy D Wing |
Corporate Officer |
Jun 1, 2011 | |
| David P Banks |
Corporate Director |
May 5, 2017 | |
| Gregory D McCulloch |
Corporate Officer |
May 5, 2014 | |
| W-2 Managing Employee |
May 5, 2014 | ||
| Brian S Reiner |
Corporate Officer |
Mar 14, 2014 | |
| Corporate Director |
May 13, 2011 | ||
| Robert a Cherry |
Corporate Director |
May 5, 2017 | |
| Adventist Health System/West |
Operational/Managerial Control | Jun 16, 1980 | 100% |
| Michelle Fuentes |
Corporate Officer |
Feb 28, 2018 | |
| W-2 Managing Employee |
Feb 28, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040316000829 | CA | Part B Supplier - Clinic/Group Practice | 4284538505 |
Receives reassigned benefits from 140 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sonora, CA |
| O20070503000608 | CA | Part a Provider - Rural Health Clinic | 4284538505 | Practice locations: Sonora, CA |
National Provider Directory
- Part of
- Sonora Community Hospit
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | |||
| Dentist |
122300000X | |||
| Dermatology Physician |
207N00000X | |||
| Emergency Medicine Physician |
207P00000X | |||
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Gastroenterology Physician |
207RG0100X | |||
| Pulmonary Disease Physician |
207RP1001X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Orthopaedic Surgery Physician |
207X00000X | |||
| Otolaryngology Physician |
207Y00000X | |||
| Pediatrics Physician |
208000000X | |||
| Surgery Physician |
208600000X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
193 Fairview LN
Sonora, CA 95370-4828
Mailing address
PO Box 398852
San Francisco, CA 94139-8852
Phone (209) 536-3900
Other names
- Forest Road Health & Wellness Center
Other providers in Sonora, CA
- Barbara A Snyder
- Stacey Soares
- Anne Lynn Sobczak
- Solo Internal Medicine
- Sonora Anesthesia Services a Medical Group Inc
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
All providers in Sonora, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2019. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.