NPIMap

Organization Active NPI

Kaweah Delta Health Care District

Doing business as Kaweah Health Woodlake Clinic

  • Rural Health Clinic/Center
  • Woodlake, CA
National Provider Identifier
1154614097
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
120000580 Issued in CA
Legal business name
KAWEAH DELTA HEALTH CARE DISTRICT
Doing business as
Kaweah Health Woodlake Clinic
Practice address
180 E Antelope Ave
Woodlake, CA 93286-1506
Phone
(559) 624-2000
Fax
(559) 713-2356
NPI assigned
May 25, 2011
Last updated
Apr 20, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
KAWEAH DELTA HEALTH CARE DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Authorized official

Name
Malinda Tupper
Title
SRVP/Chief Financial Officer
Phone
(559) 624-4065

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 120000580 CA Primary
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

180 E Antelope Ave
Woodlake, CA 93286-1506

Mailing address

400 W Mineral King Ave
Visalia, CA 93291-6237
Phone (559) 624-2739

Other names 1

  • Kaweah Health Woodlake Clinic Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address providerenrollment@kdhcd.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110718000162 CA Part A Provider - Rural Health Clinic 6608778790 Practice locations: Woodlake, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154614097. Details of each certification follow.

Rural health clinic certification: CCN 058659

Legal name
KAWEAH DELTA HEALTH CARE DISTRICT
Doing business as
KAWEAH HEALTH WOODLAKE CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 12, 2012
Last certification
Aug 28, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
180 E Antelope Ave
Woodlake, CA 93286-1506
Related CCNs
050057

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

Other NPIs with the same Medicare PAC ID 16

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

View all 16

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
05D2036144Kaweah Health Woodlake Clinic180 E. Antelope Ave., Woodlake, CA 93286Certificate of waiverJan 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kaweah Delta Non Inv Ca27 organizations share this tax ID, including this one
Part of
Kaweah Delta Non Inv Ca

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Gary Herbst Individual Corporate OfficerCeo Sep 1, 2017
W-2 Managing Employee Jun 1, 2011
Lynn Mirviss Individual Corporate DirectorBoard Vice President Zone II Jun 1, 2011
Anthony Olmos Individual Corporate DirectorBoard Member, Zone I Dec 4, 2020
Ambar Rodriguez Individual Corporate DirectorBoard Member, Zone V Dec 4, 2020
Garth Gipson Individual Corporate Director Jan 13, 2020
Benjamin Cripps Individual Corporate OfficerVP Chief Compliance & Risk Officer Feb 12, 2017
W-2 Managing EmployeeVP Chief Compliance & Risk Officer Feb 12, 2017
Malinda Tupper Individual Corporate OfficerSr. VP/Cfo Feb 4, 2018
W-2 Managing EmployeeDirector of Revenue Cycle Apr 24, 2017
Keri Noeski Individual Corporate OfficerVP Chief Nursing Office Jun 28, 2020
W-2 Managing EmployeeVP Chief Nursing Office Jun 28, 2020
Marc Mertz Individual Corporate OfficerVP Chief Strategy Officer Oct 1, 2018
W-2 Managing EmployeeVP Chief Strategy Officer Oct 1, 2018
Kaweah Delta Health Care District Organization, Visalia, CA Other Jan 12, 2012
David Francis Individual Corporate DirectorBoard President, Zone IV Mar 22, 2018
Ryan Gates Individual Corporate OfficerVP of Population Health Mar 1, 2020
W-2 Managing EmployeeVP of Population Health Mar 1, 2020

Owners & managing parties with NPI records 16

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

View all 16

All facility ownership & control disclosures 11

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

FacilityTypeRoleSince
Kaweah Health Medical CenterVisalia, CA, CCN 050057 Hospital Operational/Managerial Control Jul 1, 1967
Kaweah Health Rehabilitation HospitalVisalia, CA, CCN 05T057 Hospital 5% Or Greater Direct Ownership Interest Nov 26, 2007
Kaweah Health Mental Health HospitalVisalia, CA, CCN 05S057 Hospital 5% Or Greater Direct Ownership Interest Nov 26, 2007
Kaweah Health Skilled Nursing CenterVisalia, CA, CCN 555396 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Oct 24, 1989
Dec 16, 2024
Jan 7, 2025
Kaweah Health Home HealthVisalia, CA, CCN 057255 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jul 17, 2008
Kaweah Health HospiceVisalia, CA, CCN 051748 Hospice 5% Or Greater Direct Ownership Interest (100%) May 16, 2002
Kaweah Health Exeter ClinicExeter, CA, CCN 058508 Rural health clinic 5% Or Greater Direct Ownership Interest Jul 17, 2008
Kaweah Health Lindsay ClinicLindsay, CA, CCN 058649 Rural health clinic 5% Or Greater Direct Ownership Interest Jun 19, 2009
Kaweah Health Dinuba ClinicDinuba, CA, CCN 058677 Rural health clinic Operational/Managerial Control Sep 1, 2014
Kaweah Health Tulare ClinicTulare, CA, CCN 058717 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2021
Kaweah Health Valencia ClinicWoodlake, CA, CCN 058734 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 19, 2025

Owned or controlled facilities with NPI records 11

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

NPI Registry JSON

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

{
    "created_epoch": "1306281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1154614097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W MINERAL KING AVE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916237",
            "telephone_number": "559-624-2739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E ANTELOPE AVE",
            "city": "WOODLAKE",
            "state": "CA",
            "postal_code": "932861506",
            "telephone_number": "559-624-2000",
            "fax_number": "559-713-2356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAWEAH DELTA HEALTH CARE DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KAWEAH DELTA HEALTH CARE DISTRICT",
        "enumeration_date": "2011-05-25",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "TUPPER",
        "authorized_official_first_name": "MALINDA",
        "authorized_official_title_or_position": "SRVP/CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "559-624-4065"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "120000580",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "providerenrollment@kdhcd.org",
            "affiliation": "N",
            "address_1": "180 E Antelope Ave",
            "city": "Woodlake",
            "state": "CA",
            "country_code": "US",
            "postal_code": "932861506",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaweah Health Woodlake Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodlake, CA

Sources for this page

Verify at the official NPI Registry.