Redding Rancheria

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

20A7013 Issued in CA

Legal business name

REDDING RANCHERIA

Practice address

1441 Liberty St
Redding, CA 96001-0811

Phone

(530) 226-1753

Fax

(530) 224-2723

NPI assigned

Jul 9, 2006

Last updated

Sep 21, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lori Hernandez

Title

Billing Manager

Phone

(530) 226-1740

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104859354. Details of each certification follow.

• CCN 051901 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 051901

Legal name

REDDING RANCHERIA

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 1, 1992

Last certification

Jan 1, 1992

Ownership / control type

For profit – corporation

Organization structure

GovernmentNon-profit

Enrollment address

1441 Liberty Street
Redding, CA 96001-0848

Other NPIs with the same Medicare PAC ID 2

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

• Redding Rancheria

  dba Redding Rancheria Trinity Health Center

  • Federally Qualified Health Center (FQHC)
  • Weaverville, CA
  • NPI 1386164580

  7810969847

  Same PAC ID
• Redding Rancheria

  dba Redding Rancheria Center for Advanced Care

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1780423244

  7810969847

  Same PAC ID

Other NPIs on the same Medicare enrollment 3

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

• Redding Rancheria

  dba Redding Rancheria Trinity Health Center

  • Federally Qualified Health Center (FQHC)
  • Weaverville, CA
  • NPI 1386164580

  O20040810001377

  Same enrollment
• Redding Rancheria

  dba Redding Rancheria Center for Advanced Care

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1780423244

  O20040810001377

  Same enrollment
• Redding Rancheria

  dba Central Valley Healthcare

  • Federally Qualified Health Center (FQHC)
  • Shasta Lake, CA
  • NPI 1831724053

  O20040810001377

  Same enrollment

All disclosed owners & managing parties 4

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

Owners & managing parties with NPI records 3

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

• Paul Richard Davis, D.O.

  • Family Medicine Physician
  • Redding, CA
  • NPI 1609989532

  W-2 Managing Employee

  CMS ownership
• Redding Rancheria

  dba Redding Rancheria Trinity Health Center

  • Federally Qualified Health Center (FQHC)
  • Weaverville, CA
  • NPI 1386164580

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Redding Rancheria

  dba Redding Rancheria Center for Advanced Care

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1780423244

  5% Or Greater Direct Ownership Interest

  CMS ownership

All facility ownership & control disclosures 2

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

Owned or controlled facilities with NPI records 2

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

• Redding Rancheria

  dba Redding Rancheria Trinity Health Center

  • Federally Qualified Health Center (FQHC)
  • Weaverville, CA
  • NPI 1386164580

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• Redding Rancheria

  dba Redding Rancheria Center for Advanced Care

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1780423244

  5% Or Greater Direct Ownership Interest

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Redding Rancheria

  dba Redding Rancheria Trinity Health Center

  • Federally Qualified Health Center (FQHC)
  • Weaverville, CA
  • NPI 1386164580

  Redding Rancheria

  CMS ownership
• Redding Rancheria

  dba Redding Rancheria Center for Advanced Care

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1780423244

  Redding Rancheria

  CMS ownership

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Misty Barnett, LCSW

  • Social Worker
  • Redding, CA
  • NPI 1134358211
  Medicare reassignment Care Compare group NPD
• Kara Anne Carmona Russell, LCSW

  • Clinical Social Worker
  • Redding, CA
  • NPI 1699291591
  Medicare reassignment Care Compare group NPD
• Rachel Chavez, LCSW, PPS

  • Clinical Social Worker
  • Redding, CA
  • NPI 1932517455
  Medicare reassignment Care Compare group NPD
• Faith Clause, FNP

  • Nurse Practitioner
  • Redding, CA
  • NPI 1093250862
  Medicare reassignment Care Compare group NPD
• Paul Richard Davis, D.O.

  • Family Medicine Physician
  • Redding, CA
  • NPI 1609989532
  Medicare reassignment Care Compare group NPD
• Norma Ellenwood

  • Marriage & Family Therapist
  • Redding, CA
  • NPI 1356726756
  Medicare reassignment Care Compare group NPD
• Matthew Grana, D.O.

  • Family Medicine Physician
  • Redding, CA
  • NPI 1750739934
  Medicare reassignment Care Compare group NPD
• Michelle Hudleston, PA-C

  • Physician Assistant
  • Redding, CA
  • NPI 1346676574
  Medicare reassignment Care Compare group NPD
• Sara Hurn

  • Marriage & Family Therapist
  • Redding, CA
  • NPI 1750807731
  Medicare reassignment Care Compare group NPD
• Mohamed H Khan, M.D.

  • Interventional Cardiology Physician
  • Redding, CA
  • NPI 1649230988
  Medicare reassignment Care Compare group NPD
• Jolene Angel Kingsley, DO

  • Family Medicine Physician
  • Redding, CA
  • NPI 1639195837
  Medicare reassignment Care Compare group NPD
• Michael Chad Kingsley, DO

  • Family Medicine Physician
  • Red Bluff, CA
  • NPI 1427078393
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632182400000",
    "number": "1104859354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 LIBERTY ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010848",
            "telephone_number": "530-226-1753",
            "fax_number": "530-224-2723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 LIBERTY ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010811",
            "telephone_number": "530-226-1753",
            "fax_number": "530-224-2723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDDING RANCHERIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "530-226-1740"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "20A7013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP70489F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP70489F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "THP70489F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Redding Primary Care Medical Group, Inc (Hilltop Medical Clinic)
• Redding Primary Care Medical Group, Inc (Hilltop Medical Clinic West)
• Redding Radiation Oncologists PC (GenesisCare Redding Oncology Center)
• Redding Radiation Oncologists PC (Ajay K. Verma, MD)
• Redding Radiology Inc
• Redding Rancheria (Churn Creek Healthcare)
• Redding Rancheria
• Redding Rancheria (Redding Rancheria Center for Advanced Care)
• Redding Rancheria (Churn Creek Wellness and Dental Care)
• Redding Rehab

• Federally Qualified Health Center (FQHC) in Redding, CA
• Providers in Redding, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.