NPIMap

Organization Active NPI

Mountain Valleys Health Centers

Doing business as Butte Valley Health Center

  • Federally Qualified Health Center (FQHC)
  • Dorris, CA
National Provider Identifier
1013088582
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAIN VALLEYS HEALTH CENTERS
Doing business as
Butte Valley Health Center
Practice address
610 West 3Rd Street
Dorris, CA 96023
Phone
(530) 397-8411
Fax
(530) 397-4567
NPI assigned
Nov 13, 2006
Last updated
Jul 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Authorized official

Name
Brandon Watkins
Title
Cfo
Phone
(530) 999-9010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

610 West 3Rd Street
Dorris, CA 96023

Mailing address

PO Box 277
Bieber, CA 96009-0277
Phone (530) 999-9010

Other identifiers 1

IdentifierTypeStateIssuer
1013088582MedicaidCA

Other names 1

  • Butte Valley Health 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
O20050429000424 CA Part B Supplier - Clinic/Group Practice 4284685538 Receives reassigned benefits from 52 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dorris, CA; Weed, CA; Tulelake, CA; Mount Shasta, CA; Fall River Mills, CA; Burney, CA; Bieber, CA
O20100804000414 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284685538 Practice locations: Dorris, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013088582. Details of each certification follow.

Federally qualified health center certification: CCN 051982

Legal name
MOUNTAIN VALLEYS HEALTH CENTERS
Doing business as
BUTTE VALLEY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 28, 1995
Last certification
Nov 28, 1995
Ownership / control type
For profit – corporation
Most recent change of ownership
Jul 1, 2001 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jan 16, 1981 in CA
Enrollment address
610W 3Rd St
Dorris, CA 96023

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

610 W 3rd St
Dorris, CA 96023
Phone (530) 397-8411

Interoperability endpoints

  • Direct secure messaging: carla.yorba@jhie.net
  • Direct secure messaging: harvey.sternberg@jhie.net
  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73477
  • Direct secure messaging: kate.west@jhie.net
  • Direct secure messaging: linda.tesman@jhie.net
  • Direct secure messaging: lucida.carpe@jhie.net
  • Direct secure messaging: michelle.abernathy@jhie.net
  • Direct secure messaging: troy.bainbridge@jhie.net

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Jana Blevins Individual Corporate DirectorBoard Member Nov 30, 2020
Edna Eades Individual Corporate DirectorBoard Member Jul 31, 2017
Shannon Gerig Individual Corporate OfficerCeo Aug 1, 2019
W-2 Managing EmployeeCeo Aug 1, 2019
Operational/Managerial ControlCeo Aug 1, 2019
John Hayes Individual Corporate DirectorBoard Member Oct 26, 2020
Susie Lorenzen Individual Corporate DirectorBoard Member Aug 31, 2020
Connie Voltura Individual Corporate DirectorBoard Member May 28, 2018
Lydia Hawkins Individual W-2 Managing EmployeeBilling Manager Mar 24, 2019
Becky Vaughan Individual Corporate DirectorBoard Member Feb 27, 2023
William James Billo Individual Corporate DirectorBoard Member Dec 1, 2016
Raul Figueroa Tamayo Individual Corporate DirectorBoard Member May 31, 2021
Edwin Stokes Individual Corporate DirectorBoard Member Nov 30, 2020
Bailey Hunt Individual W-2 Managing EmployeeBilling Manager Feb 10, 2025
Richard Fuentes Individual Corporate DirectorBoard Member Jan 5, 2011
Charlene Burgi Individual Corporate DirectorBoard Member May 28, 2018

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1013088582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277",
            "city": "BIEBER",
            "state": "CA",
            "postal_code": "960090277",
            "telephone_number": "530-999-9010",
            "fax_number": "530-294-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 WEST 3RD STREET",
            "city": "DORRIS",
            "state": "CA",
            "postal_code": "96023",
            "telephone_number": "530-397-8411",
            "fax_number": "530-397-4567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN VALLEYS HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "530-999-9010"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013088582",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Butte Valley Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Butte Valley Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dorris, CA

Sources for this page

Verify at the official NPI Registry.