Fort Bidwell Indian Community

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

FORT BIDWELL INDIAN COMMUNITY

Practice address

132 Mee Thee Uh Road
Fort Bidwell, CA 96112

Phone

(530) 279-6194

Fax

(530) 279-6288

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Candice Dawn Russell, FNP

Title

Clinic Manager

Phone

(530) 279-6194

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Warner Mountain Indian Health Project Other name

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 7

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

• Patricia Diana Chico, M.D.

  • Family Medicine Physician
  • Eureka, CA
  • NPI 1801162565

  TX

  Medicare reassignment Care Compare group
• Constance A Collins, LCSW

  • Clinical Social Worker
  • Escondido, CA
  • NPI 1477600195

  TX

  Medicare reassignment Care Compare group
• Gary Boyd Haffner, MD

  • Hospitalist Physician
  • Ft. Bidwell, CA
  • NPI 1407950710

  TX

  Medicare reassignment Care Compare group
• Robert D. Frey, M.D.

  • Interventional Pain Medicine Physician
  • Ventura, CA
  • NPI 1912934779

  TX

  Medicare reassignment
• Donna Schindler, MD

  • Psychiatry Physician
  • Oroville, CA
  • NPI 1235203597

  TX

  Medicare reassignment
• Danielle Anne Eigner, D.O

  • Family Medicine Physician
  • Bend, OR
  • NPI 1801989280

  TX

  Medicare reassignment
• Mark Clifford Goodwin, MD

  • Family Medicine Physician
  • Burney, CA
  • NPI 1396713434
  NPD (past)

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1093931107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "FORT BIDWELL",
            "state": "CA",
            "postal_code": "961120247",
            "telephone_number": "530-279-6194",
            "fax_number": "530-279-6288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 MEE THEE UH ROAD",
            "city": "FORT BIDWELL",
            "state": "CA",
            "postal_code": "96112",
            "telephone_number": "530-279-6194",
            "fax_number": "530-279-6288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT BIDWELL INDIAN COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "530-279-6194",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "THP70973F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "O5D0692143",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Warner Mountain Indian Health Project",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Gary Boyd Haffner, MD
• Jerome Ranson Simpson II, MPH, BSDH

• Rural Health Clinic/Center in Fort Bidwell, CA
• Providers in Fort Bidwell, CA by specialty
• Rural Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.