NPIMap

Organization Active NPI

McCloud Healthcare Clinic, Inc.

Doing business as Shasta Cascade Health Centers- Mt Shasta

  • Federally Qualified Health Center (FQHC)
  • Mount Shasta, CA
National Provider Identifier
1033675582
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MCCLOUD HEALTHCARE CLINIC, INC.
Doing business as
Shasta Cascade Health Centers- Mt Shasta
Practice address
824 Pine St
Mount Shasta, CA 96067-2137
Phone
(530) 926-4528
NPI assigned
Feb 20, 2019
Last updated
Nov 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MCCLOUD HEALTHCARE CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Authorized official

Name
Caleb J Ott
Title
Ceo
Phone
(530) 964-2389

Specialties & licenses 1

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

Addresses

Primary practice location

824 Pine St
Mount Shasta, CA 96067-2137

Mailing address

PO Box 1143
McCloud, CA 96057-1143
Phone (530) 964-2389

Other names 1

  • Shasta Cascade Health Centers- Mt Shasta Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118001091 CA Part B Supplier - Clinic/Group Practice 3779494919 Receives reassigned benefits from 28 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dunsmuir, CA; McCloud, CA; Mount Shasta, CA
O20190424001812 CA Part A Provider - Federally Qualified Health Center (FQHC) 3779494919 Practice locations: Mount Shasta, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033675582. Details of each certification follow.

Federally qualified health center certification: CCN 921872

Legal name
MCCLOUD HEALTHCARE CLINIC, INC.
Doing business as
SHASTA CASCADE HEALTH CENTERS- MT SHASTA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 19, 2020
Last certification
Mar 19, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 22, 1999 in CA
Enrollment address
824 Pine St
Mount Shasta, CA 96067-2137

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Urology Clinic5 organizations share this tax ID, including this one
Part of
Urology Clinic

Other organizations with this tax ID 4

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

4309 Stagecoach Rd
Dunsmuir, CA 96025
Phone (530) 235-2205

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Robin Singler Individual Corporate OfficerCfo Sep 30, 2015
W-2 Managing EmployeeCfo Sep 30, 2015
Barry Stacy Individual Corporate DirectorBoard Member May 16, 2023
James S Proffitt Individual Corporate OfficerCeo Jul 19, 2017
W-2 Managing EmployeeCeo Jul 19, 2017
Caleb Ott Individual Corporate OfficerCeo Dec 28, 2022
W-2 Managing EmployeeCeo Jan 2, 2014
Operational/Managerial ControlCeo Jan 2, 2014
Marlene Hines Individual Corporate DirectorVice President Board Dec 18, 2018
Lynda S Hilliard Individual Corporate DirectorBoard President Jun 18, 2019
Robert Hilliard Individual Corporate DirectorBoard Member Oct 18, 2022
Karen Kennedy Individual Corporate DirectorBoard Member Mar 21, 2023
Milton L Shrader Individual Corporate DirectorBoard Treasurer Feb 1, 2014
Michael Quinn Individual Corporate DirectorBoard Member Mar 21, 2023
Anita K McFall Individual Corporate Director May 1, 2008
Jennifer Roberts Individual Corporate DirectorBoard Member Dec 20, 2022

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": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730419200000",
    "number": "1033675582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1143",
            "city": "MCCLOUD",
            "state": "CA",
            "postal_code": "960571143",
            "telephone_number": "530-964-2389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 PINE ST",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672137",
            "telephone_number": "530-926-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCCLOUD HEALTHCARE CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCCLOUD HEALTHCARE CLINIC, INC.",
        "enumeration_date": "2019-02-20",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A",
        "authorized_official_last_name": "OTT",
        "authorized_official_first_name": "CALEB",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-964-2389"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shasta Cascade Health Centers- Mt Shasta",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Shasta, CA

Sources for this page

Verify at the official NPI Registry.