NPIMap

Individual provider Active NPI

Amber Ford

  • Family Nurse Practitioner
  • Fortuna, CA
National Provider Identifier
1114238797
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95029240 Issued in CA
Practice address
3302 Renner Dr
Fortuna, CA 95540-7103
Phone
(707) 725-3318
Fax
(707) 725-1998
NPI assigned
Jun 29, 2010
Last updated
Sep 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X 95029240 CA Primary

Addresses

Primary practice location

3302 Renner Dr
Fortuna, CA 95540-7103

Mailing address

720 Wood St
Eureka, CA 95501-4413
Phone (707) 268-2990

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240806002012 CA Practitioner - Nurse Practitioner 8729428420 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Health Northern California LLCGroup PAC ID 8921374562, shared by 9 NPIs, 10 clinicians

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph Health Northern California, LLC Single Specialty CurrentSince May 24, 2024 Accepting new patients
St. Joseph Health Northern California, LLC CurrentSince May 24, 2024 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 PastSince Nov 17, 2009 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

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1114238797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 WOOD ST",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955014413",
            "telephone_number": "707-268-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3302 RENNER DR",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955407103",
            "telephone_number": "707-725-3318",
            "fax_number": "707-725-1998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORD",
        "first_name": "AMBER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-29",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95029240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fortuna, CA

Sources for this page

Verify at the official NPI Registry.