NPIMap

Organization Active NPI

John C Fremont Healthcare District

Doing business as John C Fremont Healthcare District North Side

  • Family Medicine Physician
  • Coulterville, CA
National Provider Identifier
1124248901
Registry record updated Jan 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
040000108 Issued in CA
Legal business name
JOHN C FREMONT HEALTHCARE DISTRICT
Doing business as
John C Fremont Healthcare District North Side
Practice address
6386 Greeley Hill Rd
Coulterville, CA 95311-9572
Phone
(209) 966-3631
Fax
(209) 966-3776
NPI assigned
Apr 26, 2007
Last updated
Jan 7, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2014

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

Authorized official

Name
Alan G Macphee
Title
Chief Executive Officer
Phone
(209) 966-3631

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 040000108 CA Primary

Addresses

Primary practice location

6386 Greeley Hill Rd
Coulterville, CA 95311-9572

Mailing address

PO Box 216
Mariposa, CA 95338-0216
Phone (209) 966-3631

Other names 1

  • John C Fremont Healthcare District North Side Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040212000193 CA Part B Supplier - Clinic/Group Practice 5890689533 Receives reassigned benefits from 22 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coulterville, CA; Mariposa, CA
O20201228001083 CA Part A Provider - Rural Health Clinic 5890689533 Practice locations: Coulterville, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124248901. Details of each certification follow.

Rural health clinic certification: CCN 058730

Legal name
JOHN C FREMONT HEALTHCARE DISTRICT
Doing business as
JOHN C. FREMONT HEALTHCARE DISTRICT - NORTHSIDE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 27, 2023
Last certification
Dec 18, 2023
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
6386 Greeley Hill Rd
Coulterville, CA 95311-9572
Related CCNs
051304

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

5186 Hospital Rd
Mariposa, CA 95338
Phone (209) 966-0850

5189 Hospital Rd
Mariposa, CA 95338
Phone (209) 966-3631

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/fremont-d0489e1b

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Matthew Mathiesen Individual Corporate OfficerCeo Jul 29, 2013
W-2 Managing EmployeeCeo Jul 29, 2013
Candy O'Donel-Brown Individual Corporate DirectorBoard Chair Nov 25, 2003
John C Fremont Healthcare District Organization, Mariposa, CA Operational/Managerial Control Dec 10, 2007
Brenda Forrest Sweeney Individual Corporate DirectorBoard Member Nov 8, 2019
Joseph E Rogers Individual Corporate DirectorBoard Member Dec 3, 2016
Linda Woertz Pribyl Individual Corporate DirectorBoard Secretary and Treasurer Dec 5, 2014
Philip H Debry Individual Corporate DirectorBoard Member Dec 3, 2016

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
John C Fremont Healthcare DistrictMariposa, CA, CCN 051304 Hospital Operational/Managerial Control (100%) Oct 22, 2025
John C Fremont Healthcare DistrictMariposa, CA, CCN 05Z304 Hospital Other Aug 29, 1996
John C Fremont Hospital - SNFMariposa, CA, CCN 055283 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Oct 7, 1979
Oct 7, 1979
Oct 7, 1979
John C Fremont Healthcare RHCMariposa, CA, CCN 058605 Rural health clinic Other Aug 29, 1996
John C Fremont Healthcare DistrictMariposa, CA, CCN 053992 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 30, 1994

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389052800000",
    "number": "1124248901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 216",
            "city": "MARIPOSA",
            "state": "CA",
            "postal_code": "953380216",
            "telephone_number": "209-966-3631",
            "fax_number": "209-966-3776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6386 GREELEY HILL RD",
            "city": "COULTERVILLE",
            "state": "CA",
            "postal_code": "953119572",
            "telephone_number": "209-966-3631",
            "fax_number": "209-966-3776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN C FREMONT HEALTHCARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2014-01-07",
        "status": "A",
        "authorized_official_last_name": "MACPHEE",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "209-966-3631"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "040000108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "John C Fremont Healthcare District North Side",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coulterville, CA

Sources for this page

Verify at the official NPI Registry.