NPIMap

Organization Active NPI

Adventist Health Mendocino Coast

Doing business as Mendocino Coast District Hospital

  • Rural Health Clinic/Center
  • Fort Bragg, CA
National Provider Identifier
1124220249
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ADVENTIST HEALTH MENDOCINO COAST
Doing business as
Mendocino Coast District Hospital
Practice address
721 River Drive
Suite a
Fort Bragg, CA 95437
Phone
(707) 961-4631
Fax
(707) 964-1192
NPI assigned
Jun 1, 2007
Last updated
Sep 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Parker Pridgen
Title
President
Phone
(707) 456-3010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

721 River Drive
Suite a
Fort Bragg, CA 95437

Mailing address

PO Box 841941
Los Angeles, CA 90084-1941

Other names 1

  • Mendocino Coast District Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200924000857 CA Part A Provider - Rural Health Clinic 3678990769 Practice locations: Fort Bragg, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124220249. Details of each certification follow.

Rural health clinic certification: CCN 058629

Legal name
ADVENTIST HEALTH MENDOCINO COAST
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 20, 2007
Last certification
Aug 21, 2017
Ownership / control type
Non-profit – church related
Most recent change of ownership
Jul 1, 2020 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Mar 17, 2020 in CA
Enrollment address
721 River Dr
Ste a-B-C
Fort Bragg, CA 95437-5403
Related CCNs
051325

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0611996Mendocino Coast Adventist Health721 River Dr Ste a, Fort Bragg, CA 95437Certificate of waiverJul 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Adventist Health Mendocino Coast2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1627 S Hargrave St
Ste Aca
Banning, CA 92220

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/29a5ccea-f4ab-4447-a191-56b20695970f/

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Kerry L Heinrich Individual Corporate OfficerChair Jan 24, 2022
Corporate DirectorBoard Member Jan 1, 2022
Meredith S Jobe Individual Corporate OfficerSecretary Mar 18, 2020
Eric a Stevens Individual Corporate OfficerVice Chair Jul 8, 2024
Richard K Reiner Individual Corporate DirectorBoard Member Mar 18, 2020
Richard R Riter Individual Corporate OfficerTreasurer Jun 26, 2025
Stone Point Health Organization, Roseville, CA Corporation, Non-profit Operational/Managerial Control Jul 1, 2020 100%
Parker J Pridgen Individual Corporate OfficerPresident Aug 15, 2025
W-2 Managing Employee Aug 15, 2025
Larry L Innocent Individual Corporate DirectorBoard Member Mar 18, 2020

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 2

DateEventCounterparty
Jul 1, 2020 Change of OwnershipThis provider was the buyer North Coast Family Health CenterCCN 058629, CA, NPI 1124220249
Jul 1, 2020 Change of OwnershipThis provider was the seller Adventist Health Mendocino CoastCCN 058629, CA, NPI 1124220249

Practitioners & affiliated clinicians

Practitioners 97

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 97

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1124220249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 841941",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900841941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 RIVER DRIVE",
            "address_2": "SUITE A",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "95437",
            "telephone_number": "707-961-4631",
            "fax_number": "707-964-1192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST HEALTH MENDOCINO COAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "PRIDGEN",
        "authorized_official_first_name": "PARKER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-456-3010"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "721 River Drive",
            "address_2": "Suite A",
            "city": "Fort Bragg",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mendocino Coast District Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Bragg, CA

Sources for this page

Verify at the official NPI Registry.