NPIMap

Organization Active NPI

Peach Tree Healthcare

  • Federally Qualified Health Center (FQHC)
  • Olivehurst, CA
National Provider Identifier
1104526664
Registry record updated Mar 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEACH TREE HEALTHCARE
Practice address
4446 Olive Ave BLDG P-5
Olivehurst, CA 95961-4738
Phone
(530) 749-3242
Fax
(530) 743-5044
NPI assigned
Mar 3, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2023

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

Authorized official

Name
Gregory S Stone
Title
Ceo
Phone
(530) 749-3242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

4446 Olive Ave BLDG P-5
Olivehurst, CA 95961-4738

Mailing address

1114 Yuba St Ste 220
Marysville, CA 95901-4838
Phone (530) 749-3242

Other names 1

  • Peach Tree Lindhurst High School Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101104000566 CA Part B Supplier - Clinic/Group Practice 7416978440 Receives reassigned benefits from 61 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Olivehurst, CA; Yuba City, CA; Sacramento, CA; Marysville, CA; Live Oak, CA; Chico, CA
O20230508001566 CA Part A Provider - Federally Qualified Health Center (FQHC) 7416978440 Practice locations: Olivehurst, CA

Federally qualified health center certification: CCN A01150

Legal name
PEACH TREE HEALTHCARE
Doing business as
PEACH TREE LINDHURST HIGH SCHOOL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 11, 2023
Last certification
Apr 11, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 21, 1995 in CA
Enrollment address
4446 Olive Ave
BLDG P-5
Olivehurst, CA 95961-4738

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Peach Tree Healthcare9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

1114 Yuba St
Ste 220
Marysville, CA 95901
Phone (240) 816-4358

4446 Olive Ave
Bldg P5
Olivehurst, CA 95961

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Veronica Avila Individual W-2 Managing EmployeeController Jun 1, 2004
Leanne Link Individual Corporate DirectorBoard Secretary/Treasurer Mar 27, 2025
Robert Bendorf Individual Corporate DirectorBoard Vice Chair May 24, 2024
Emilio Flores Individual Corporate DirectorBoard Member Oct 9, 2025
Monika Lee Individual Corporate DirectorBoard Member Aug 29, 2024
Michelle Woodard Individual Corporate OfficerCoo Dec 3, 2024
W-2 Managing EmployeeAd; Jun 1, 2016
Ngoc-Phuong T Luu Individual Corporate DirectorBoard Member Apr 1, 2020
Renick House Individual Corporate DirectorBoard Member Feb 27, 2025
Chundeep Sidhu Individual Corporate DirectorBoard Member Sep 25, 2025
Tracie Riggs Individual Corporate OfficerCeo Feb 27, 2025
Gregory Barker Individual Corporate OfficerCfo Mar 13, 2025
Erika Laine Summers Individual Corporate DirectorBoard Chair Jul 1, 2020
Awni Allababidi Individual Corporate DirectorBoard Member Oct 1, 2017
Edward Anthony Kalpas Individual Corporate OfficerCmo Nov 10, 2025
Donald Blaser Individual Corporate DirectorBoard Member Feb 1, 2021

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Peach Tree North SacramentoSacramento, CA, CCN 751916 Federally qualified health center Operational/Managerial Control Jul 10, 2012
Peach Tree HealthcareYuba City, CA, CCN 921009 Federally qualified health center Operational/Managerial Control Feb 1, 2017

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1677801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677801600000",
    "number": "1104526664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 YUBA ST STE 220",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959014838",
            "telephone_number": "530-749-3242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4446 OLIVE AVE BLDG P-5",
            "city": "OLIVEHURST",
            "state": "CA",
            "postal_code": "959614738",
            "telephone_number": "530-749-3242",
            "fax_number": "530-743-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH TREE HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-03",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-749-3242"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach Tree Lindhurst High School",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olivehurst, CA

Sources for this page

Verify at the official NPI Registry.