NPIMap

Organization Active NPI

Plumas District Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Quincy, CA
National Provider Identifier
1043616428
Registry record updated Aug 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
05Z326 Issued in CA
Legal business name
PLUMAS DISTRICT HOSPITAL
Practice address
1065 Bucks Lake Rd
Quincy, CA 95971-9507
Phone
(530) 283-2121
Fax
(530) 283-7953
NPI assigned
Nov 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2017

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X CA
Medicare Defined Swing Bed Hospital Unit 275N00000X 05Z326 CA Primary
Critical Access Hospital 282NC0060X 230000030 CA

Addresses

Primary practice location

1065 Bucks Lake Rd
Quincy, CA 95971-9507

Mailing address

1065 Bucks Lake Rd
Quincy, CA 95971-9507
Phone (530) 283-2121

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150212001550 CA Part A Provider - Critical Access Hospital 8224930466 Practice locations: Quincy, CA

Hospital certification: CCN 05Z326

Legal name
PLUMAS DISTRICT HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
1065 Bucks Lake Rd
Quincy, CA 95971-9507
Other Hospital Practice Location

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

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 5

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, 2018
Jodee L Read Individual Corporate OfficerCeo Nov 26, 2018
Karen Story Individual W-2 Managing EmployeeMedical Staff Coordinator Dec 15, 2014
Nicole Sigle Individual W-2 Managing EmployeeController Feb 1, 2021
Plumas District Hospital Organization, Quincy, CA Operational/Managerial Control Jan 1, 1966

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 Rural Health CenterQuincy, CA, CCN 053989 Rural health clinic Other Jan 1, 1995
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

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1415750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503446400000",
    "number": "1043616428",
    "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": "530-283-2121",
            "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": "530-283-2121",
            "fax_number": "530-283-7953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLUMAS DISTRICT HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-12",
        "last_updated": "2017-08-23",
        "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": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "CA",
            "license": "05Z326",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "CA",
            "license": "230000030",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, CA

Sources for this page

Verify at the official NPI Registry.