Peach Tree Healthcare
Organization Active NPI Federally Qualified Health Center (FQHC) · Marysville, CA
NPI 1114643871 · NPPES record last updated Nov 8, 2022
Key facts
- NPI
- 1114643871
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- PEACH TREE HEALTHCARE
- Practice address
- 120 5TH St RM 1
Marysville, CA 95901-5734 - Phone
- (530) 749-3242
- Fax
- (530) 749-3248
- NPI assigned
- Oct 14, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- PEACH TREE HEALTHCARE
Authorized official
- Name
- Greg Scott Stone
- Title
- Ceo
- Phone
- (530) 741-6245
Owners & managing parties with NPI records 1
-
Edward Anthony Kalpas, M.D.
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 8
Practitioners 34
-
Melinda Astran, MD
-
Leslie Jeanne Ballard, M.D.
-
Arka Prava Bhattacharya, M.D.
-
John Bressan, ACNP
-
Joseph Wayne Cassady, D.O.
-
Benson Chin, MD
-
Marvi Dhaliwal, MD
-
Lillian Griffiths, LMFT
-
Kaitlin Wright Hensley, PA-C
-
Jackson M Lim, D.P.M.
-
Robert Keith McAfee Jr., M.D.
-
Mark Miller, LCSW
-
Michael Jeffrey Neal, D.O.
-
Angela Ngo, OD
-
Madeline Nguyen, D.O.
-
Amanda O'Hara, DO
-
Rosanna Lynn Perry, LCSW
-
Sonata Demesha Poon, FNP-BC, PMHNP-BC
-
Charles Nolan Price, D.C.
-
Rocio Castro Rosas, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN A01138
- Legal name
- PEACH TREE HEALTHCARE
- Doing business as
- PEACH TREE YUBA COUNTY PROBATION
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Dec 12, 2022
- Last certification
- Dec 12, 2022
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 21, 1995 in CA
- Enrollment address
- 120 5TH St
RM 1
Marysville, CA 95901-5734
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Veronica Avila |
W-2 Managing Employee |
Jun 1, 2004 | |
| Leanne Link |
Corporate Director |
Mar 27, 2025 | |
| Robert Bendorf |
Corporate Director |
May 24, 2024 | |
| Emilio Flores |
Corporate Director |
Oct 9, 2025 | |
| Monika Lee |
Corporate Director |
Aug 29, 2024 | |
| Michelle Woodard |
Corporate Officer |
Dec 3, 2024 | |
| W-2 Managing Employee |
Jun 1, 2016 | ||
| Ngoc-Phuong T Luu |
Corporate Director |
Apr 1, 2020 | |
| Renick House |
Corporate Director |
Feb 27, 2025 | |
| Chundeep Sidhu |
Corporate Director |
Sep 25, 2025 | |
| Tracie Riggs |
Corporate Officer |
Feb 27, 2025 | |
| Gregory Barker |
Corporate Officer |
Mar 13, 2025 | |
| Erika Laine Summers |
Corporate Director |
Jul 1, 2020 | |
| Awni Allababidi |
Corporate Director |
Oct 1, 2017 | |
| Edward Anthony Kalpas |
Corporate Officer |
Nov 10, 2025 | |
| Donald Blaser |
Corporate Director |
Feb 1, 2021 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Peach Tree North Sacramento |
Federally qualified health center | Operational/Managerial Control | Jul 10, 2012 |
| Peach Tree Healthcare |
Federally qualified health center | Operational/Managerial Control | Feb 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101104000566 | CA | Part B Supplier - Clinic/Group Practice | 7416978440 |
Receives reassigned benefits from 61 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Olivehurst, CA; Yuba City, CA; Sacramento, CA; Marysville, CA; Live Oak, CA; Chico, CA |
| O20221222001936 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 7416978440 | Practice locations: Marysville, CA |
National Provider Directory
- Tax ID family
- Peach Tree Healthcare
- Part of
- Peach Tree Healthcare
Locations
915 8th St
Rm 1
Marysville, CA 95901
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
120 5TH St RM 1
Marysville, CA 95901-5734
Mailing address
1114 Yuba St Ste 220
Marysville, CA 95901-4838
Phone (530) 749-3242
Other names
- Peach Tree Yuba County Probation
Other providers in Marysville, CA
- Isamar Patino
- Patrick K Griffith MD PC
- Amanda Mia Patterson
- Peach Tree Clinic Inc
- Peach Tree Healthcare
- Peach Tree Healthcare
- Peach Tree Healthcare
- Peach Tree Healthcare
- Ana Jasmin Perdomo
- Paulo Alexandro Perez
All providers in Marysville, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2022. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.