NPIMap

Organization Active NPI

Sonora Community Hospital

Doing business as Forest Road Health & Wellness Center

  • Rural Health Clinic/Center
  • Sonora, CA
National Provider Identifier
1003014952
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SONORA COMMUNITY HOSPITAL
Doing business as
Forest Road Health & Wellness Center
Practice address
193 Fairview LN
Sonora, CA 95370-4828
Phone
(209) 536-5100
Fax
(209) 536-5108
NPI assigned
Jul 3, 2007
Last updated
Aug 22, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
SONORA COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Authorized official

Name
Gregory D McCulloch
Title
Ceo
Phone
(209) 536-5011

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 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

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 1

  • Forest Road Health & Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003014952. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jan 1, 1984 in CA
Enrollment address
193 Fairview LN
Sonora, CA 95370-4828
Related CCNs
050335

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

Other NPIs with the same Medicare PAC ID 9

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.

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
05D0934430Sonora Community Hospital Dba193 S Fairview Lane, Sonora, CA 95370Certificate of waiverSep 30, 2026

National Provider Directory

National Provider Directory
Part of
Sonora Community

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Kerry L Heinrich Individual Corporate DirectorBoard Member Dec 16, 2014
Meredith S Jobe Individual Corporate OfficerSecretary Mar 31, 2014
Billy D Wing Individual Corporate OfficerAsst Secr Jun 1, 2011
David P Banks Individual Corporate DirectorBoard Member May 5, 2017
Gregory D McCulloch Individual Corporate OfficerCfo/Asst Secretary May 5, 2014
W-2 Managing EmployeeSr VP/Cfo May 5, 2014
Brian S Reiner Individual Corporate OfficerChairman of the Board Mar 14, 2014
Corporate DirectorChairman of the Board May 13, 2011
Robert a Cherry Individual Corporate DirectorBoard Member May 5, 2017
Adventist Health System/West Organization, Roseville, CA Non-profit Operational/Managerial Control Jun 16, 1980 100%
Michelle Fuentes Individual Corporate OfficerPresident Feb 28, 2018
W-2 Managing EmployeePresdient/Ceo Feb 28, 2018

Facilities with the same owner 105

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 105

Practitioners & affiliated clinicians

Practitioners 136

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 136

NPI Registry JSON

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

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566432000000",
    "number": "1003014952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398852",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941398852",
            "telephone_number": "209-536-3900",
            "fax_number": "209-533-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "193 FAIRVIEW LN",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953704828",
            "telephone_number": "209-536-5100",
            "fax_number": "209-536-5108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONORA COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SONORA COMMUNITY HOSPITAL",
        "enumeration_date": "2007-07-03",
        "last_updated": "2019-08-22",
        "status": "A",
        "authorized_official_last_name": "MCCULLOCH",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-536-5011"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forest Road Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Forest Road Health & Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.