Adventist Health Clearlake Hospital Inc.
Organization Active NPI Critical Access Hospital · Clearlake, CA
NPI 1124018031 · NPPES record last updated Sep 15, 2025
Key facts
- NPI
- 1124018031
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 110000174 (CA)
- Legal business name
- ADVENTIST HEALTH CLEARLAKE HOSPITAL INC.
- Practice address
- 15630 18TH Ave
Clearlake, CA 95422-6710 - Phone
- (707) 994-6486
- Fax
- (707) 995-3631
- NPI assigned
- Oct 24, 2005
- Organization subpart
- No
Authorized official
- Name
- Parker J Pridgen
- Title
- President
- Phone
- (707) 467-5200
Owners & managing parties with NPI records 1
-
Kenneth Jutzy, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 11
Related certifications (CCN) 11
Facilities with the same owner 105
Practitioners 242
-
Pari Azari, M.D.
-
Erin Bennett, MSN, APRN, FNP-BC
-
Ruben R Brechner, M.D.
-
Susan Carreon, M.S.W.
-
Amber Leighan Chatwin, M.D.
-
Jack L Chen, M.D.
-
Andrew K Chinnock, FNP
-
Leonardo C. Clavijo, M.D.
-
William Duge, MD
-
Juan C. Esteva, MD
-
William V Glenn, MD
-
Laurie K Halversen, LCSW
-
Curtis Han, DC
-
David Bruce Jackson, M.D.
-
Sean L Johnston, M.D., PH.D.
Affiliated clinicians 450
-
Joy Marie Ackles, FNP
-
Natashya Marie Adams, FNP-C
-
Chalice Ann Addis, FNP-BC
-
Yewande Adepoju, DO
-
Adour Richard Adrouny, M.D.
-
David G Alonso, MD
-
Francisco Javier Alvarez, M.D.
-
Sarah Fearing Alvord, M.D.
-
Avanti Ambekar, M.D.
-
Fariba Amiri, M.D.
-
Paolo Andreassi, M.D.
-
Anna Marie Antonowich, MSN, NP-BC
-
Julie Ann Archer, M.D.
-
Razi M Arifuddin, MD
-
Fadi Arodaki, DO
-
Elise B. Asghar, MD
-
Nasrin Ashouian, MD
-
Thomas W Axelrad, M.D.
-
Christopher Ayeko, FNP
-
Pari Azari, M.D.
-
Diane Elizabeth Bajada, MSN, FNP
-
Christopher Paul Banks, PA-C
-
Stephen J Banks, MD
Medicare Care Compare: Hospital
- Listed as
- Adventist Health Clearlake
- Overall star rating
- ★★☆☆☆ 2 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in CA
Hospital certification: CCN 051317
- Legal name
- ADVENTIST HEALTH CLEARLAKE HOSPITAL INC.
- Doing business as
- ADVENTIST HEALTH CLEAR LAKE
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Apr 12, 2005
- Last certification
- Feb 27, 2026
- Beds
- 32
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 14, 1996 in CA
- Enrollment address
- 15630 18TH Ave
Clearlake, CA 95422-9336
Hospital certification: CCN 05Z317
- Legal name
- ADVENTIST HEALTH CLEARLAKE HOSPITAL INC.
- Doing business as
- ADVENTIST HEALTH CLEAR LAKE
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 14, 1996 in CA
- Enrollment address
- 15630 18TH Ave
Clearlake, CA 95422-9336
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Kerry L Heinrich |
Corporate Officer |
Jan 1, 2022 | |
| Corporate Director |
Dec 15, 2014 | ||
| Velino a Salazar |
Corporate Director |
Sep 15, 2015 | |
| Meredith S Jobe |
Corporate Officer |
Mar 31, 2014 | |
| Richard K Reiner |
Corporate Director |
Jan 16, 2017 | |
| Joy a. Fehr |
Corporate Director |
Oct 1, 2020 | |
| Jonathan J Daggett |
Corporate Director |
Jan 1, 2024 | |
| Andrew R Davis |
Corporate Director |
May 5, 2017 | |
| Todd N Hofheins |
Corporate Officer |
Jan 24, 2022 | |
| Ann K Beckett |
Corporate Director |
Jan 1, 2024 | |
| Marc K Woodson |
Corporate Director |
Jan 1, 2019 | |
| John C Freedman |
Corporate Director |
Sep 26, 2016 | |
| Jeffrey R Mock |
Corporate Officer |
Sep 18, 2023 | |
| Jack W Wagner |
Corporate Director |
Jan 1, 2024 | |
| Corporate Director |
Dec 1, 2022 | ||
| Kenneth Jutzy |
Corporate Director |
Jan 1, 2024 | |
| Bradford C Newton |
Corporate Director |
Aug 16, 2021 | |
| Robert a Cherry |
Corporate Director |
May 5, 2017 | |
| Larry L Innocent |
Corporate Director |
Sep 19, 2011 | |
| Corporate Director |
Jun 1, 2015 | ||
| Judson Howe |
Corporate Officer |
May 3, 2024 | |
| W-2 Managing Employee |
May 3, 2024 | ||
| Adventist Health System/West |
Operational/Managerial Control | Jul 1, 1997 | 100% |
| John H Cress |
Corporate Director |
Oct 1, 2024 | |
| Eric a Stevens |
Corporate Officer |
Jul 8, 2024 | |
| W-2 Managing Employee | Jul 8, 2024 | ||
| Richard R Riter |
Corporate Officer |
Jun 24, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041112000573 | CA | Part B Supplier - Clinic/Group Practice | 3072421197 |
Receives reassigned benefits from 187 practitioners 1 other NPI on this enrollment Practice locations: Clearlake, CA |
| O20071116000572 | CA | Part a Provider - Critical Access Hospital | 3072421197 |
Receives reassigned benefits from 35 practitioners Practice locations: Clearlake, CA; Lakeport, CA; Hidden Valley Lake, CA |
| O20080619000664 | CA | Part a Provider - Critical Access Hospital | 3072421197 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clearlake, CA |
National Provider Directory
Locations
15322 Lakeshore Dr
Ste 204
Clearlake, CA 95422
Phone (707) 995-5624
15140 Lakeshore Dr
Clearlake, CA 95422
Phone (707) 995-4500
15630 18th Ave
#53
Clearlake, CA 95422
895 Trancas St
Ste A
Napa, CA 94558
Phone (707) 252-2020
1572 Railroad Ave
Saint Helena, CA 94574
3727 Buchanan St
Ste 310
San Francisco, CA 94123
Phone (415) 563-1655
501 E St
Williams, CA 95987
Phone (530) 473-5641
975 North St
Ste 201
Boulder, CO 80304
Phone (303) 440-7941
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 110000174 | CA | Yes |
Addresses
Primary practice location
15630 18TH Ave
Clearlake, CA 95422-6710
Mailing address
PO Box 888837
Los Angeles, CA 90088-8837
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSP40539G | Medicaid | CA | |
| ZZZC1702Z | Other | CA | BLUE SHIELD INPATIENT |
| ZZR00539G | Medicaid | CA |
Other names
- Adventist Health Clear Lake
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Bluemark LLC / Office Ally |
Other providers in Clearlake, CA
- Adventist Health California Medical Group, Inc.
- Adventist Health California Medical Group, Inc.
- Adventist Health California Medical Group, Inc.
- Adventist Health California Medical Group, Inc.
- Adventist Health Clearlake Hospital Inc
- Adventist Health Clearlake Hospital Inc.
- Adventist Health Clearlake Hospital Inc.
- Adventist Health Physician Network
- Adventist Health Physicians Network
- Adventist Health Physicians Network
All providers in Clearlake, CA · Critical Access Hospital 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 15, 2025. 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.