Eastern Plumas Health Care District
Organization Active NPI Rural Health Clinic/Center · Portola, CA
NPI 1114923919 · NPPES record last updated Dec 21, 2022
Key facts
- NPI
- 1114923919
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 058522 (CA)
- Legal business name
- EASTERN PLUMAS HEALTH CARE DISTRICT
- Practice address
- 480 1St Ave
Portola, CA 96122-9405 - Phone
- (530) 832-6600
- NPI assigned
- Jun 27, 2005
- Organization subpart
- No
Authorized official
- Name
- Jerilee Nelson, CPA
- Title
- Cfo
- Phone
- (530) 832-6578
Owners & managing parties with NPI records 7
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 11
Related certifications (CCN) 2
Practitioners 34
-
Michael Paul Brooks, D.P.M.
-
Barnett J. W. Grier Jr., M.D.
-
Trevor Allen Daniels, PSY.D.
-
Milind Dhond, M. D.
-
Alfred Fernandez, MD
-
Corey Stephen Gonzales, PH.D.
-
Ben Martin Hunt, MD
-
William M Mills, M.D.
-
Marc Nielsen, DO
-
Daniel S. Pine, MD
-
Michael Plessas, P.A.
-
Raymundo P Punzalan, M.D.
-
Daniel Stoll, MD
-
Jennifer Vimbor, MS, RD
-
Quang Dinh Vo, MD
-
Irene Wojtkiewicz, N.P.
-
Robert Adams, D.O.
-
Daniel J Coll, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0684180 | Portola Medical Clinic | Certificate of waiver | Mar 8, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Rural health clinic certification: CCN 058522
- Legal name
- EASTERN PLUMAS HEALTH CARE DISTRICT
- Doing business as
- PORTOLA MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Dec 4, 1995
- Last certification
- Nov 6, 2015
- Ownership / control type
- Non-profit – church related
- Organization structure
- Government · Non-profit
- Incorporated
- Aug 5, 1991 in CA
- Enrollment address
- 480 1St Ave
Portola, CA 96122-9405 - Related CCNs
- 051300
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Gail McGrath |
Corporate Director | Jun 1, 2013 | |
| Eastern Plumas Health Care District |
Other | Jan 1, 2013 | |
| Paul S Swanson |
Corporate Director | Jun 1, 2013 | |
| Katherine a Pairish |
Corporate Officer |
Jan 1, 2019 | |
| W-2 Managing Employee |
Jan 1, 2019 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Eastern Plumas Health Care |
Hospital | Operational/Managerial Control | Oct 24, 2000 |
| Eastern Plumas Health Care |
Skilled nursing facility | Other | Sep 11, 1990 |
| Eastern Plumas Health Care District |
Rural health clinic | Other | Jan 1, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111228000583 | CA | Part a Provider - Rural Health Clinic | 4587576889 | Practice locations: Portola, CA |
National Provider Directory
- Tax ID family
- Eastern Plumas District
Locations
480 1st Ave
Portola, CA 96122
Phone (530) 832-6600
145 N Pine St
Portola, CA 96122
Phone (530) 832-4425
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator |
171M00000X | |||
| Rural Health Clinic/Center | 261QR1300X | 058522 | CA | Yes |
| Rural Health Clinic/Center | 261QR1300X | 230000014 | CA |
Addresses
Primary practice location
480 1St Ave
Portola, CA 96122-9405
Mailing address
500 1St Ave
Portola, CA 96122-9406
Phone (530) 832-6600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RHM18522F | Medicaid | CA | |
| ZZZ30855Z | Other | CA | BLUE SHILED CLINIC PRO FE |
Other names
- EASTERN PLUMAS HEALTH CARE PORTOLA
Other providers in Portola, CA
- Eastern Plumas Health Care
- Eastern Plumas Health Care
- Eastern Plumas Health Care
- Eastern Plumas Health Care
- Eastern Plumas Health Care District
- Eastern Plumas Health Care District
- Eastern Plumas Health Care District
- Eastern Plumas Health Care District
- Eastern Plumas Health Care District
- Eastern Plumas Health Care District
All providers in Portola, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 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.
- 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.