NPIMap

Organization Active NPI

Shasta Community Health Center

Doing business as Shasta Community Telemedicine and Training Center

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
National Provider Identifier
1114533171
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHASTA COMMUNITY HEALTH CENTER
Doing business as
Shasta Community Telemedicine and Training Center
Practice address
1756 Continental St
Redding, CA 96001-1240
Phone
(530) 246-5710
NPI assigned
Sep 16, 2020
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Mr. Jeffery Brandon Thornock
Title
Chief Executive Officer
Phone
(530) 246-5074

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU
Rheumatology Physician 207RR0500X NU
Maternal & Fetal Medicine Physician 207VM0101X NU
Neurology Physician 2084N0400X NU
Psychiatry Physician 2084P0800X NU
Child & Adolescent Psychiatry Physician 2084P0804X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1756 Continental St
Redding, CA 96001-1240

Mailing address

PO Box 992790
Redding, CA 96099-2790
Phone (530) 246-5710

Other names 1

  • Shasta Community Telemedicine and Training Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040629000721 CA Part B Supplier - Clinic/Group Practice 3870579816 Receives reassigned benefits from 156 practitioners
6 other NPIs on this enrollment
Practice locations: Anderson, CA; Redding, CA; Shasta Lake, CA
O20201119002767 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870579816 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Redding, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114533171. Details of each certification follow.

Federally qualified health center certification: CCN 921929

Legal name
SHASTA COMMUNITY HEALTH CENTER
Doing business as
SHASTA COMMUNITY HEALTH CENTER URGENT CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 12, 2020
Last certification
Nov 12, 2020
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
980 Placer St
Redding, CA 96001-1126

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Laura Baynard Individual Corporate OfficerChief Operations Officer Mar 3, 2024
W-2 Managing EmployeeChief Operations Officer Mar 3, 2024
Stephen Bell Individual Corporate DirectorConsumer Member Jan 28, 2021
Christy Coleman Individual Corporate DirectorCounty of Shasta Member Apr 27, 2023
Alicia Torge Individual Corporate Director Sep 25, 2025
Daniel Santi Individual Corporate OfficerChief Financial Officer Aug 24, 2023
W-2 Managing EmployeeChief Financial Officer Aug 24, 2023
Michael Mangas Individual Corporate DirectorConsumer Member Jul 25, 2019
Robert Folden Individual Corporate DirectorProvider Member Vice Chair Dec 31, 2021
Brian Bradley Individual Corporate DirectorConsumer Member Nov 14, 2024
Wendy Longwell Individual Corporate DirectorTreasurer Jun 25, 2014
Anastasiia Borysiuk Individual Corporate DirectorConsumer Member Mar 28, 2024
John Kenny Individual Corporate DirectorVice Chair Apr 22, 2013
Samantha Breton Individual Corporate DirectorConsumer Member Oct 27, 2022
Lawrence Vogt Individual Corporate Director Jun 27, 2024
Kerry Fasking Individual Corporate DirectorConsumer Member Chair Jul 24, 2013
Brandon Thornock Individual Corporate OfficerChief Executive Officer Oct 1, 2017
W-2 Managing EmployeeChief Executive Officer Oct 1, 2017
Margaret Beck Individual Corporate DirectorSecretary Feb 23, 2017
Dot Van Cleave Individual Corporate DirectorConsumer Member Sep 28, 2017

Practitioners & affiliated clinicians

Practitioners 156

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 156

NPI Registry JSON

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

{
    "created_epoch": "1600214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1114533171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 992790",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960992790",
            "telephone_number": "530-246-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1756 CONTINENTAL ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011240",
            "telephone_number": "530-246-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASTA COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-16",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "THORNOCK",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "530-246-5074",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207VM0101X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Maternal & Fetal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shasta Community Telemedicine and Training Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shasta Community Telemedicine and Training Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.