Amber Ford
Individual provider Active NPI Family Nurse Practitioner · Fortuna, CA
NPI 1114238797 · NPPES record last updated Sep 4, 2024
Key facts
- NPI
- 1114238797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 95029240 (CA)
- Practice address
- 3302 Renner Dr
Fortuna, CA 95540-7103 - Phone
- (707) 725-3318
- Fax
- (707) 725-1998
- NPI assigned
- Jun 29, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 10
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Joseph Health Northern California LLC
Practice addresses (Care Compare)
3300 Renner Dr
Fortuna, CA 95540-3120
Phone (707) 725-3361
3300 Renner Dr
Fortuna, CA 95540-3198
3302 Renner Dr
Fortuna, CA 95540-7103
Phone (707) 725-3318
Hospital & facility affiliations
- Providence St Joseph Hospital
- Providence Redwood Memorial Hospital
- Mad River Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240806002012 | CA | Practitioner - Nurse Practitioner | 8729428420 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95029240 | CA | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Joseph Health Northern California, LLC | Current |
Accepting new patients | |
| St. Joseph Health Northern California, LLC | Single Specialty | Current |
Accepting new patients |
| St. Joseph Health Northern California, LLC | Single Specialty | Current | Accepting new patients |
| Philip L. Olkin, M.D. and C. Ray Jones, M.D. | Single Specialty | Past |
Accepting new patients |
Locations
3302 Renner Dr
Fortuna, CA 95540
Phone (707) 725-3318
3302 Renner Dr
Ste A
Fortuna, CA 95540
Phone (707) 725-3318
1000 Trancas St
Napa, CA 94558
Phone (707) 226-2901
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | |||
| Family Nurse Practitioner |
363LF0000X | 95029240 | CA | Yes |
Addresses
Primary practice location
3302 Renner Dr
Fortuna, CA 95540-7103
Mailing address
720 Wood St
Eureka, CA 95501-4413
Phone (707) 268-2990
Other providers in Fortuna, CA
- Katherine Anne Talbert Estlin
- Family Foot Care Specialist Podiatry Center
- Family Foot Care Specialists Podiatry Center Inc
- Neal E Feuerman
- Ana Fernanda Fierro
- Fortuna Assisted Living LLC
- Fortuna Chiropractic LLC
- Fortuna Elementary School District
- Fortuna Family Medical Group Inc
- Fortuna Family Medicine Inc.
All providers in Fortuna, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.