NPIMap

Organization Active NPI

John C. Fremont Healthcare District

Doing business as John C Fremont Hlthcare RHC

  • Family Medicine Physician
  • Mariposa, CA
National Provider Identifier
1043433568
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
040000108 Issued in CA
Legal business name
JOHN C. FREMONT HEALTHCARE DISTRICT
Doing business as
John C Fremont Hlthcare RHC
Practice address
5186 Hospital Rd
Mariposa, CA 95338-9524
Phone
(209) 966-3631
Fax
(209) 966-3776
NPI assigned
Apr 11, 2007
Last updated
Feb 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Authorized official

Name
Matthew A Mathiessen
Title
Ceo
Phone
(209) 966-3631

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 040000108 CA Primary

Addresses

Primary practice location

5186 Hospital Rd
Mariposa, CA 95338-9524

Mailing address

PO Box 216
Mariposa, CA 95338-0216
Phone (209) 966-3631

Other names 1

  • John C Fremont Hlthcare RHC Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL jcfadm@jcf-hospital.com

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040212000193 CA Part B Supplier - Clinic/Group Practice 5890689533 Receives reassigned benefits from 22 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coulterville, CA; Mariposa, CA
O20041217000866 CA Part A Provider - Rural Health Clinic 5890689533 Practice locations: Mariposa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043433568. Details of each certification follow.

Rural health clinic certification: CCN 058605

Legal name
JOHN C FREMONT HEALTHCARE DISTRICT
Doing business as
JOHN C FREMONT HEALTHCARE RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 18, 2005
Last certification
Sep 14, 2017
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
May 26, 1947 in CA
Enrollment address
5189 Hospital Rd
Mariposa, CA 95338-9524
Related CCNs
051304

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Wendy Lou Ryder-Priola Individual Corporate DirectorBoard Chair Dec 2, 2022
Jessica Robichaux Individual W-2 Managing EmployeeMedical Staff Supervisor Nov 1, 2025
Stacey Kuzak Individual Corporate OfficerCeo Oct 17, 2025
Teresa Johnson Individual Corporate DirectorBoard Director Dec 2, 2022
John C Fremont Healthcare District Organization, Mariposa, CA Non-profit Other Aug 29, 1996
Jesse Bullis Individual Corporate DirectorBoard Director, Secretary-Treasurer Dec 2, 2022
Rachel Key Individual Corporate OfficerChief Nursing Officer/Cao Nov 1, 2025
W-2 Managing EmployeeAd; Oct 29, 2024
Rose Ann Fluharty Individual Corporate DirectorBoard Director, Vice Dec 2, 2022

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
John C Fremont Healthcare DistrictMariposa, CA, CCN 051304 Hospital Operational/Managerial Control (100%) Oct 22, 2025
John C Fremont Healthcare DistrictMariposa, CA, CCN 05Z304 Hospital Other Aug 29, 1996
John C Fremont Hospital - SNFMariposa, CA, CCN 055283 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Oct 7, 1979
Oct 7, 1979
Oct 7, 1979
John C Fremont Healthcare DistrictMariposa, CA, CCN 053992 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 30, 1994
John C. Fremont Healthcare District - Northside ClinicCoulterville, CA, CCN 058730 Rural health clinic Operational/Managerial Control Dec 10, 2007

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 4

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": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1043433568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 216",
            "city": "MARIPOSA",
            "state": "CA",
            "postal_code": "953380216",
            "telephone_number": "209-966-3631",
            "fax_number": "209-966-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5186 HOSPITAL RD",
            "city": "MARIPOSA",
            "state": "CA",
            "postal_code": "953389524",
            "telephone_number": "209-966-3631",
            "fax_number": "209-966-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN C. FREMONT HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "MATHIESSEN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-966-3631"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "040000108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "jcfadm@jcf-hospital.com",
            "affiliation": "N",
            "address_1": "5186 Hospital Rd",
            "city": "Mariposa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "953389524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "John C Fremont Hlthcare RHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "John C Fremont Hlthcare RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mariposa, CA

Sources for this page

Verify at the official NPI Registry.