NPIMap

Organization Active NPI

Plumas District Hospital

  • Rural Health Clinic/Center
  • Quincy, CA
National Provider Identifier
1043348543
Registry record updated Dec 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
230000030 Issued in CA
Legal business name
PLUMAS DISTRICT HOSPITAL
Practice address
1065 Bucks Lake Rd
Quincy, CA 95971-9507
Phone
(530) 283-7161
Fax
(530) 283-7953
NPI assigned
Feb 28, 2007
Organization subpart
Yes
Parent organization
PLUMAS DISTRICT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 8, 2015

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

Authorized official

Name
Jeffrey Kepple, MD
Title
Ceo
Phone
(530) 283-7127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 230000030 CA Primary

Addresses

Primary practice location

1065 Bucks Lake Rd
Quincy, CA 95971-9507

Mailing address

1065 Bucks Lake Rd
Quincy, CA 95971-9507
Phone (530) 283-7161

Other names 1

  • Plumas Rural Health Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110114000602 CA Part A Provider - Rural Health Clinic 8224930466 Practice locations: Quincy, CA

Rural health clinic certification: CCN 053989

Legal name
PLUMAS DISTRICT HOSPITAL
Doing business as
PLUMAS RURAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 19, 1992
Last certification
Apr 22, 2014
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
1065 Bucks Lake Rd
Quincy, CA 95971-9507
Related CCNs
051326

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Plumas District Hospital6 organizations share this tax ID, including this one
Part of
Plumas District Hospital

Other organizations with this tax ID 5

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

Locations

1065 Bucks Lake Rd
Quincy, CA 95971
Phone (530) 283-2121

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d09b5303-02b3-4cca-b4b2-ddf355d54e88/

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Caleb Johnson Individual Corporate OfficerCfo Jul 6, 2015
Jodee L Read Individual Corporate OfficerCeo Nov 26, 2018
Nicole Sigle Individual W-2 Managing EmployeeController Feb 1, 2021
Plumas District Hospital Organization, Quincy, CA Other Jan 1, 1995

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Plumas District HospitalQuincy, CA, CCN 051326 Hospital Other Jan 1, 1995
Plumas District HospitalQuincy, CA, CCN 05Z326 Hospital Operational/Managerial Control Jan 1, 1966
Indian Valley Medical ClinicGreenville, CA, CCN 058636 Rural health clinic Other Jan 1, 1966

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1043348543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1065 BUCKS LAKE RD",
            "city": "QUINCY",
            "state": "CA",
            "postal_code": "959719507",
            "telephone_number": "530-283-7161",
            "fax_number": "530-283-7953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1065 BUCKS LAKE RD",
            "city": "QUINCY",
            "state": "CA",
            "postal_code": "959719507",
            "telephone_number": "530-283-7161",
            "fax_number": "530-283-7953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLUMAS DISTRICT HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PLUMAS DISTRICT HOSPITAL",
        "enumeration_date": "2007-02-28",
        "last_updated": "2015-12-08",
        "status": "A",
        "authorized_official_last_name": "KEPPLE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-283-7127",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "230000030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plumas Rural Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Quincy, CA

Sources for this page

Verify at the official NPI Registry.