Southern Inyo Healthcare District
Organization Active NPI Rural Health Clinic/Center · Lone Pine, CA
NPI 1063589174 · NPPES record last updated Jan 23, 2019
Key facts
- NPI
- 1063589174
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 240000205 (CA)
- Legal business name
- SOUTHERN INYO HEALTHCARE DISTRICT
- Practice address
- 510 E. Locust
Lone Pine, CA 93545 - Phone
- (760) 876-1146
- Fax
- (760) 876-4046
- NPI assigned
- Nov 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Brian F. Cotter, R.N.
- Title
- Ceo
- Phone
- (760) 876-5501
Owners & managing parties with NPI records 1
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 3
Related certifications (CCN) 1
Practitioners 93
-
Pardeep Athwal, M.D.
-
Michael Blue, M.D.
-
Stacey Lee Brown, MD
-
Ismael Ramirez Cota, FNP
-
Todd Allen Farrer, M.D.
-
John Joe Fosbinder, D.O.
-
Nicholas Glover, DO
-
Francisco Lazaga, MD
-
Haleh Nekoorad-Long, M.D.
-
Ronald Joseph Ostrom, D.O.
-
Michael Phillips, MD
-
David A. Smith, M.D.
-
Todd William Chapman, M.D.
-
Jasiri Kennedy, M.D.
-
Christopher James Rowan, M.D.
-
Jules A Silver, MD
-
Balveen Singh, D.O.
-
Sandra S. Spiedel, N.P.
-
Amar Manoj Amin, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1010801 | Southern Inyo Rural Health Clinic | Certificate of waiver | Mar 23, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Rural health clinic certification: CCN 058511
- Legal name
- SOUTHERN INYO HEALTHCARE DISTRICT
- Doing business as
- SOUTHERN INYO RURAL HEALTH CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 9, 1995
- Last certification
- Jul 10, 2013
- Ownership / control type
- Non-profit – church related
- Organization structure
- Other · Proprietary
- Incorporated
- Jul 5, 1949 in CA
- Enrollment address
- 510 E Locust Street
Lone Pine, CA 93545-1009 - Related CCNs
- 051302
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Maritza Perkins |
W-2 Managing Employee |
Dec 8, 2017 | |
| Jaque Hickman |
Corporate Director |
Jan 1, 2018 | 100% |
| Peter Spiers |
Contracted Managing Employee |
Jul 30, 2019 | 100% |
| Corporate Officer |
Jul 30, 2019 | 100% | |
| Operational/Managerial Control |
Jul 30, 2019 | 100% | |
| Yarenith Hernandez |
W-2 Managing Employee |
Jan 13, 2016 | |
| Southern Inyo Healthcare District |
Other | Jan 1, 1966 | 100% |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Southern Inyo Hospital |
Hospital | Operational/Managerial Control (100%) | Aug 1, 2019 |
| Southern Inyo Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | Jan 1, 1966 |
| Southern Inyo Hospital Skilled Nursing Facility |
Skilled nursing facility | Direct Ownership Interest (100%) | Jan 1, 1966 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030422000077 | CA | Part a Provider - Rural Health Clinic | 7911816731 |
1 other NPI on this enrollment Practice locations: Lone Pine, CA |
| O20040317000188 | CA | Part B Supplier - Clinic/Group Practice | 7911816731 |
Receives reassigned benefits from 99 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lone Pine, CA |
National Provider Directory
- Tax ID family
- Southern Inyo Healthcar
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 240000205 | CA | Yes |
Addresses
Primary practice location
510 E. Locust
Lone Pine, CA 93545
Mailing address
PO Box 1009
Lone Pine, CA 93545
Phone (760) 876-1146
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05-8511 | Other | CA | MEDICARE ID TYPE UNSPECIFIED |
Other names
- Southern Inyo Hospital
Other providers in Lone Pine, CA
- Cyrus Andris Pourzan
- Premier Emergency Physicians of California Medical Group PC
- Helen X Qian
- Dennis J Schumacher
- Robert Seitz
- Southern Inyo Healthcare District
- Southern Inyo Hospical
- Southern Inyo Hospital
- Southern Inyo Hospital
- Loraine Spreacker
All providers in Lone Pine, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2019. 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.