Sonora Community Hospital
Organization Active NPI General Practice Physician · Sonora, CA
NPI 1063403129 · NPPES record last updated Apr 2, 2013
Key facts
- NPI
- 1063403129
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Physician 208D00000X
- Legal business name
- SONORA COMMUNITY HOSPITAL
- Practice address
- 650 Pauline CT
Sonora, CA 95370-5210 - Phone
- (209) 532-5154
- Fax
- (209) 533-7696
- NPI assigned
- Oct 28, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- SONORA COMMUNITY HOSPITAL
Authorized official
- Name
- Andrew D. Jahn
- Title
- Vice President for Finance
- Phone
- (209) 536-5011
Owners & managing parties with NPI records 1
-
Kenneth Jutzy, M.D.
Other NPIs on the same Medicare enrollment 11
Related certifications (CCN) 2
Affiliated clinicians 493
-
Humayun Abbas, MD
-
Loui Abdelghani, M.D
-
Ariana Abid, MD
-
Estevan Acuna, FNP
-
Abulaiti Adili, M.D.
-
Roozbeh A. Ahmadi, M.D.
-
Keren Akakpo, PA-C
-
Haytham Aljoudi, MD
-
Avni Amin, MD
-
Michelle L Apperson, M.D., PH.D.
-
Andres Alberto Arellano, M.D.
-
Masoud Asgari, M.D.
-
Edward Leonard Auen, PH.D., M.D.
-
Mark Velimir Avdalovic, M.D.
-
Harry Balian, M.D.
-
Mussa Banisadre, MD
Medicare Care Compare: Hospital
- Listed as
- Adventist Health Sonora
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Church
- Medicare certification status
- Active
- Emergency services
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Hospital certification: CCN 050335
- Legal name
- SONORA COMMUNITY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Jun 13, 2023
- Beds
- 143 (75 certified)
- Ownership / control type
- Church
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 24, 1958 in CA
- Enrollment address
- 1000 Greenley Rd
Sonora, CA 95370-5200 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Kerry L Heinrich |
Corporate Officer |
Jan 1, 2022 | |
| Corporate Director |
Dec 16, 2014 | ||
| Velino a Salazar |
Corporate Director |
Sep 15, 2015 | |
| Meredith S Jobe |
Corporate Officer |
Mar 31, 2014 | |
| Richard K Reiner |
Corporate Director |
Jan 16, 2017 | |
| Joy a. Fehr |
Corporate Director |
Oct 1, 2020 | |
| Jonathan J Daggett |
Corporate Director |
Jan 1, 2024 | |
| Andrew R Davis |
Corporate Director |
May 5, 2017 | |
| Todd N Hofheins |
Corporate Officer |
Jan 24, 2022 | |
| Ann K Beckett |
Corporate Director |
Jan 1, 2024 | |
| Marc K Woodson |
Corporate Director |
Jan 1, 2019 | |
| John C Freedman |
Corporate Director |
Sep 26, 2016 | |
| Gregory D McCulloch |
Corporate Officer |
May 29, 2024 | |
| W-2 Managing Employee |
May 5, 2014 | ||
| Jack W Wagner |
Corporate Director |
Dec 1, 2022 | |
| Kenneth Jutzy |
Corporate Director |
Jan 1, 2024 | |
| Bradford C Newton |
Corporate Director |
Aug 16, 2021 | |
| Robert a Cherry |
Corporate Officer |
May 5, 2017 | |
| Larry L Innocent |
Corporate Director |
Jun 1, 2015 | |
| Adventist Health System/West |
Operational/Managerial Control | Jun 16, 1980 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071214000277 | CA | Part a Provider - Hospital | 4284538505 |
16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Angels Camp, CA; Sonora, CA; Groveland, CA; Arnold, CA |
National Provider Directory
- Part of
- Sonora Community Hospit
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | Yes |
Addresses
Primary practice location
650 Pauline CT
Sonora, CA 95370-5210
Mailing address
14542 Lolly LN
Sonora, CA 95370-9226
Phone (209) 536-3900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ52952Z | Other | CA | BLUE CROSS/BLUE SHIELD |
Other names
- Foothill Primary Care
Other providers in Sonora, CA
- Solo Internal Medicine
- Sonora Anesthesia Services a Medical Group Inc
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
- Sonora Community Hospital
All providers in Sonora, CA · General Practice Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.