Kaiser Foundation Hospitals

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

010000259 Issued in CA

Legal business name

KAISER FOUNDATION HOSPITALS

Doing business as

Kaiser Foundation Hospital Home Health Santa Rosa

Practice address

3550 Round Barn Blvd Ste 112
Santa Rosa, CA 95403-1796

Phone

(707) 566-5488

NPI assigned

Nov 9, 2006

Last updated

Apr 22, 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

Judith L Coffey

Title

Senior Vice President, Area Manager

Phone

(797) 571-4222

Specialties & licenses 1

Addresses

Other names 1

• Kaiser Foundation Hospital Home Health Santa Rosa Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104996933. Details of each certification follow.

• CCN 057407 Home health agency · Active · Details

Home health agency certification: CCN 057407

Legal name

KAISER FOUNDATION HOSPITALS

Doing business as

KAISER PERMANENTE HOSPITAL HOME HEALTH SANTA ROSA

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jun 16, 1993

Last certification

Jan 28, 2019

Ownership / control type

Non-Profit

Organization structure

CorporationNon-profit

Incorporated

Feb 19, 1948 in CA

Enrollment address

3550 Round Barn Blvd
Ste 112
Santa Rosa, CA 95403-1796

Listed as

Kaiser Foundation Hospital Home Health Santa RosaCCN 057407 · All quality measures

Overall star rating

2 of 5

Ownership

Non-Profit

Certified

Jun 16, 1993

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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

CLIA laboratory certificates

Member organizations 9

Organizations listed as members of this organization in the National Provider Directory.

• Port City Operating Company, LLC

  dba St. Joseph's Behavioral Health Center

  • Psychiatric Hospital
  • Stockton, CA
  • NPI 1053443473

  Member Of

  NPD member
• Port City Operating Company, LLC

  • Home Health Agency
  • Stockton, CA
  • NPI 1306978945

  Member Of

  NPD member
• Port City Operating Company, LLC

  dba St. Joseph's Medical Center of Stockton

  • General Acute Care Hospital
  • Stockton, CA
  • NPI 1528190931

  Member Of

  NPD member
• Priva Path Labs, Inc

  dba LetsGetChecked Labs

  • Clinical Medical Laboratory
  • Monrovia, CA
  • NPI 1063036689

  Member Of

  NPD member
• Maui Health System a Kaiser Foundation Hospitals LLC

  dba Maui Memorial Medical Center

  • General Acute Care Hospital
  • Wailuku, HI
  • NPI 1013379460

  Member Of

  NPD member
• Maui Health System a Kaiser Foundation Hospitals LLC

  dba Skilled Nursing and Intermediate Care Facility Kula Hospital

  • Nursing Facility/Intermediate Care Facility
  • Kula, HI
  • NPI 1184079956

  Member Of

  NPD member
• Maui Health System a Kaiser Foundation Hospitals LLC

  dba Lanai Community Hospital

  • Critical Access Hospital
  • Lanai City, HI
  • NPI 1336501634

  Member Of

  NPD member
• Maui Health System a Kaiser Foundation Hospitals LLC

  dba Lanai Community Hospital Skilled Nursing and Intermediate Care Facilit

  • Nursing Facility/Intermediate Care Facility
  • Lanai, HI
  • NPI 1841645959

  Member Of

  NPD member
• Maui Health System a Kaiser Foundation Hospitals LLC

  dba Kula Hospital

  • Critical Access Hospital
  • Kula, HI
  • NPI 1861854226

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 19

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 1

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

• Regina M Benjamin, MD

  • Family Medicine Physician
  • Bayou la Batre, AL
  • NPI 1033188339

  Corporate Director

  CMS ownership

All facility ownership & control disclosures 79

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

Facilities with the same owner 78

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

• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital San Diego

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1013062769

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Hospice Program

  • Community Based Hospice Care Agency
  • West Covina, CA
  • NPI 1053466953

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Inland Empire Hospice

  • Community Based Hospice Care Agency
  • Fontana, CA
  • NPI 1053466961

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Hospice - Martinez

  • Community Based Hospice Care Agency
  • Martinez, CA
  • NPI 1053487793

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Mental Health Ctr DP AHP

  • Psychiatric Hospital Unit
  • Los Angeles, CA
  • NPI 1063567956

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital San Jose

  • General Acute Care Hospital
  • San Jose, CA
  • NPI 1063582989

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital - Roseville

  • General Acute Care Hospital
  • Roseville, CA
  • NPI 1073811378

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Fresno

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1083784672

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Los Angeles HHA

  • Home Health Agency
  • Pasadena, CA
  • NPI 1124173059

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital West Los Angeles

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1134274897

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital San Francisco

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1134299522

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital - Orange County - Anaheim Medical Center

  • General Acute Care Hospital
  • Anaheim, CA
  • NPI 1144375056

  Kaiser Foundation Hospitals

  CMS ownership

Practitioners 4

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.

• Damien Michael Brunner, P.T.

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1063963981
  NPD (past)
• Suzanne Edwards, PT

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1548515844
  NPD (past)
• Teresa Lin Fry

  • Occupational Therapist
  • Santa Rosa, CA
  • NPI 1558846477
  NPD (past)
• Heather Lea Massie, PT

  • Physical Therapist
  • Santa Rosa, CA
  • NPI 1124187166
  NPD (past)

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1104996933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 ROUND BARN BLVD STE 112",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031796",
            "telephone_number": "707-566-5488",
            "fax_number": "707-566-5702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3550 ROUND BARN BLVD STE 112",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031796",
            "telephone_number": "707-566-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "COFFEY",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT, AREA MANAGER",
        "authorized_official_telephone_number": "797-571-4222"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "010000259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "3550 Round Barn Blvd Ste 112",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954031796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Foundation Hospital Home Health Santa Rosa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Foundation Hospital Home Health Santa Rosa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kaiser Foundation Health Plan Inc (Kaiser Permanente Pharmacy #588)
• Kaiser Foundation Health Plan Inc
• Kaiser Foundation Health Plan Inc (Kaiser Pharmacy 1 West Pharmacy 581)
• Kaiser Foundation Health Plan Inc (Kaiser Permanente Pharmacy #587)
• Kaiser Foundation Hospitals (Kaiser Found Hospital Phy #58B)
• Kaiser Foundation Hospitals (Kaiser Foundation Hospital Santa Rosa)
• Kaiser Foundation Hospitals (Kaiser Foundationn Hospital Inp/Out Hospital Pharmacy 58a 58)
• Kaiser Permanente
• Christine Kaiser, M.D.
• Elizabeth A. Kaiser, RN, PHN

• Home Health Agency in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.
• 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.