NPIMap

Organization Active NPI

Eastern Plumas Health Care District

Doing business as Eastern Plumas Health Care

  • Medicare Defined Swing Bed Hospital Unit
  • Portola, CA
National Provider Identifier
1164428967
Registry record updated Dec 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
05Z300 Issued in CA
Legal business name
EASTERN PLUMAS HEALTH CARE DISTRICT
Doing business as
Eastern Plumas Health Care
Practice address
500 1St Ave
Portola, CA 96122-9406
Phone
(530) 832-6500
Fax
(530) 832-1105
NPI assigned
Jun 27, 2005
Last updated
Dec 30, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2013

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

Authorized official

Name
Ms. Jerilee Nelson, CPA
Title
Cfo
Phone
(530) 832-6578

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 05Z300 CA Primary
Medicare Defined Swing Bed Hospital Unit 275N00000X 230000014 CA

Addresses

Primary practice location

500 1St Ave
Portola, CA 96122-9406

Mailing address

500 1St Ave
Portola, CA 96122-9406
Phone (530) 832-6500

Other names 1

  • EASTERN PLUMAS HEALTH CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170223002615 CA Part A Provider - Critical Access Hospital 4587576889 Practice locations: Portola, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164428967. Details of each certification follow.

Hospital certification: CCN 05Z300

Legal name
EASTERN PLUMAS HEALTH CARE DISTRICT
Organization structure
CorporationNon-profit
Enrollment address
500 1St Ave
Portola, CA 96122-9406
Other Hospital Practice Location

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).

National Provider Directory

National Provider Directory
Tax ID family
Eastern Plumas Hospital12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

181 E Sierra Ave
Portola, CA 96122

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Gail McGrath Individual Corporate Director Apr 1, 2007
Paul S Swanson Individual Corporate Director Jan 3, 2014
Katherine a Pairish Individual Corporate OfficerCfo Jan 1, 2019
W-2 Managing EmployeeCfo Jan 1, 2019

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Eastern Plumas Health CarePortola, CA, CCN 051300 Hospital Operational/Managerial Control Oct 24, 2000
Eastern Plumas Health CarePortola, CA, CCN 555433 Skilled nursing facility Other Sep 11, 1990
Eastern Plumas Health Care DistrictGraeagle, CA, CCN 553985 Rural health clinic Other Jan 1, 2013
Portola Medical ClinicPortola, CA, CCN 058522 Rural health clinic Other Jan 1, 2013

Owned or controlled facilities with NPI records 5

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

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

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388361600000",
    "number": "1164428967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 1ST AVE",
            "city": "PORTOLA",
            "state": "CA",
            "postal_code": "961229406",
            "telephone_number": "530-832-6500",
            "fax_number": "530-832-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 1ST AVE",
            "city": "PORTOLA",
            "state": "CA",
            "postal_code": "961229406",
            "telephone_number": "530-832-6500",
            "fax_number": "530-832-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN PLUMAS HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2013-12-30",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JERILEE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "530-832-6578",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "CA",
            "license": "05Z300",
            "primary": true
        },
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "CA",
            "license": "230000014",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EASTERN PLUMAS HEALTH CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portola, CA

Sources for this page

Verify at the official NPI Registry.