NPIMap

Organization Active NPI

Seneca Healthcare District

Doing business as Lake Almanor Clinic

  • Rural Health Clinic/Center
  • Chester, CA
National Provider Identifier
1104920438
Registry record updated May 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SENECA HEALTHCARE DISTRICT
Doing business as
Lake Almanor Clinic
Practice address
199 Reynolds Road
Chester, CA 96020
Phone
(530) 258-2826
Fax
(530) 258-3471
NPI assigned
Sep 8, 2006
Last updated
May 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2014

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

Authorized official

Name
Linda Wagner
Title
Ceo
Phone
(530) 258-2067

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

199 Reynolds Road
Chester, CA 96020

Mailing address

P.O. Box 737
Chester, CA 96020
Phone (530) 258-2151

Other identifiers 1

IdentifierTypeStateIssuer
RHM08593FMedicaidCA

Other names 1

  • Lake Almanor Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030312000027 CA Part A Provider - Rural Health Clinic 8820907140 Practice locations: Chester, CA
O20031210001061 CA Part B Supplier - Clinic/Group Practice 8820907140 Receives reassigned benefits from 38 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chester, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104920438. Details of each certification follow.

Rural health clinic certification: CCN 058593

Legal name
SENECA HEALTHCARE DISTRICT
Doing business as
LAKE ALMANOR CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 9, 2003
Last certification
Jun 21, 2018
Ownership / control type
1B
Organization structure
OtherNon-profit
Enrollment address
199 Reynolds Road
Chester, CA 96020
Related CCNs
051327

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0895132Seneca Healthcare District199 Reynolds Road, Chester, CA 96020Provider-performed microscopyNov 29, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Steve Boline Individual Corporate OfficerCfo Mar 18, 2018
W-2 Managing EmployeeCfo Mar 18, 2018 100%
Seneca Healthcare District Organization, Chester, CA Operational/Managerial Control Jun 1, 2007

Owners & managing parties with NPI records 2

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
Seneca HospitalChester, CA, CCN 051327 Hospital Operational/Managerial Control Jun 1, 2007
Seneca HospitalChester, CA, CCN 05Z327 Hospital Operational/Managerial Control Jun 1, 2007

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400630400000",
    "number": "1104920438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 737",
            "city": "CHESTER",
            "state": "CA",
            "postal_code": "96020",
            "telephone_number": "530-258-2151",
            "fax_number": "530-258-3471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 REYNOLDS ROAD",
            "city": "CHESTER",
            "state": "CA",
            "postal_code": "96020",
            "telephone_number": "530-258-2826",
            "fax_number": "530-258-3471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENECA HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2014-05-21",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-258-2067"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM08593F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Almanor Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chester, CA

Sources for this page

Verify at the official NPI Registry.