NPIMap

Organization Active NPI

Hazel Hawkins Memorial Hospital

Doing business as Hazel Hawkins primary Care & Surgical Specialty Center

  • Rural Health Clinic/Center
  • Hollister, CA
National Provider Identifier
1013628353
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HAZEL HAWKINS MEMORIAL HOSPITAL
Doing business as
Hazel Hawkins primary Care & Surgical Specialty Center
Practice address
930 Sunset Dr Building 1 Ste C
Hollister, CA 95023-5620
Phone
(831) 630-1019
Fax
(831) 630-0691
NPI assigned
Dec 7, 2022
Last updated
Feb 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Authorized official

Name
Mary Casillas
Title
Ceo
Phone
(831) 635-1455

Specialties & licenses 1

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

Addresses

Primary practice location

930 Sunset Dr Building 1 Ste C
Hollister, CA 95023-5620

Mailing address

911 Sunset Dr
Hollister, CA 95023-5606
Phone (831) 636-2626

Other names 1

  • Hazel Hawkins primary Care & Surgical Specialty Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240503003297 CA Part A Provider - Rural Health Clinic 9133038326 Practice locations: Hollister, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013628353. Details of each certification follow.

Rural health clinic certification: CCN 058731

Legal name
HAZEL HAWKINS MEMORIAL HOSPITAL
Doing business as
HAZEL HAWKINS PRIMARY CARE & SURGICAL SPECIALTY CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 29, 2024
Last certification
Jul 29, 2024
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
930 Sunset Dr Building 1 Ste C
Hollister, CA 95023-5620
Related CCNs
051337

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

Other NPIs with the same Medicare PAC ID 7

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

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
05D2284459Hazel Hawkins Primary Care & Surgical Specialty Ce930 Sunset Dr BLDG 1 Ste C, Hollister, CA 95023Certificate of waiverJun 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hazel Hawkins HSP Rad D10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

911 Sunset Dr
#C
Hollister, CA 95023
Phone (831) 638-1111

930 Sunnyslope Rd
Ste C2
Hollister, CA 95023
Phone (831) 636-7950

930 Sunset Dr
Hollister, CA 95023
Phone (650) 248-8481

930 Sunset Dr
Ste C
Hollister, CA 95023
Phone (831) 630-1019

991 4th St
Hollister, CA 95023
Phone (831) 636-3277

301 The Alameda
Ste B3
San Juan Bautista, CA 95045
Phone (831) 623-4615

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Jerrianne M Hernandez Individual Corporate DirectorBoard Member, President Nov 1, 2016
Andrea Posey Individual Corporate OfficerInterim Chief Nursing Officer Oct 7, 2023
W-2 Managing EmployeeInterim Chief Nursing Officer Oct 7, 2023
Mary T Casillas Individual W-2 Managing EmployeeCeo May 31, 2022
Operational/Managerial ControlInterim Ceo May 31, 2022 30%
Josefa Sanchez Individual Corporate DirectorBoard Member, Secretary Nov 1, 2014
William Johnson Individual Corporate DirectorBoard Member, Vice President Nov 1, 2020
Mark T Robinson Individual W-2 Managing EmployeeChief Financial Officer Feb 19, 2001
Operational/Managerial ControlChief Financial Officer Feb 19, 2001 30%
Richard Shelton Individual Corporate DirectorBoard Member, Treasurer Nov 1, 2020

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Mabie First Street Healthcare CenterHollister, CA, CCN 058660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2012
Barragan Family Health Care and Diabetes CenterHollister, CA, CCN 058705 Rural health clinic Operational/Managerial Control (100%) Dec 15, 2005

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 72

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 72

NPI Registry JSON

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

{
    "created_epoch": "1670371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1013628353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 SUNSET DR",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235606",
            "telephone_number": "831-636-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 SUNSET DR BUILDING 1 STE C",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235620",
            "telephone_number": "831-630-1019",
            "fax_number": "831-630-0691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL HAWKINS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-07",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "CASILLAS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "831-635-1455"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazel Hawkins primary Care & Surgical Specialty Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollister, CA

Sources for this page

Verify at the official NPI Registry.