NPIMap

Organization Active NPI

Hazel Hawkins Memorial Hospital

  • Rural Health Clinic/Center
  • Hollister, CA
National Provider Identifier
1205076536
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HAZEL HAWKINS MEMORIAL HOSPITAL
Practice address
321 1St St
Hollister, CA 95023-3712
Phone
(831) 637-5711
Fax
(831) 636-2668
NPI assigned
Feb 26, 2009
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Mrs. Mary Casillas
Title
Chief Executive Officer
Phone
(831) 635-1455

Specialties & licenses 1

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

Addresses

Primary practice location

321 1St St
Hollister, CA 95023-3712

Mailing address

321 1St St
Hollister, CA 95023-3729
Phone (831) 638-1652

Other names 1

  • Mabie First Street Healthcare Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111031000340 CA Part A Provider - Rural Health Clinic 9133038326 Practice locations: Hollister, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205076536. Details of each certification follow.

Rural health clinic certification: CCN 058660

Legal name
HAZEL HAWKINS MEMORIAL HOSPITAL
Doing business as
MABIE FIRST STREET HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 2012
Last certification
Nov 7, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Enrollment address
321 1St St
Hollister, CA 95023-3712
Related CCNs
050296

Other NPIs with the same Medicare PAC ID 7

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
05D1102484Mabie First Street Healthcare Center321 First St, Hollister, CA 95023Certificate of waiverOct 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Hazel Hawkins HSP Rad D10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

321 1st St
Hollister, CA 95023
Phone (619) 507-0303

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Jerrianne M Hernandez Individual Corporate DirectorBoard Member Nov 1, 2016
Steven Hannah Individual Corporate OfficerChief Executive Officer Nov 1, 2020 50%
W-2 Managing EmployeeChief Executive Officer Nov 1, 2020 50%
Josefa Sanchez Individual Corporate DirectorBoard Member Nov 1, 2014
Mark T Robinson Individual Corporate OfficerCfo Feb 19, 2001 50%
Corporate Director Nov 1, 2020
W-2 Managing Employee Nov 1, 2020
Hazel Hawkins Memorial Hospital Organization, Hollister, CA Created for acquisition 5% Or Greater Direct Ownership Interest Jun 1, 2012 100%

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Barragan Family Health Care and Diabetes CenterHollister, CA, CCN 058705 Rural health clinic Operational/Managerial Control (100%) Dec 15, 2005

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1235606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1205076536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 1ST ST",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950233729",
            "telephone_number": "831-638-1652",
            "fax_number": "831-638-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 1ST ST",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950233712",
            "telephone_number": "831-637-5711",
            "fax_number": "831-636-2668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL HAWKINS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-26",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "CASILLAS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "831-635-1455",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mabie First Street Healthcare Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Mabie First Street Healthcare Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hollister, CA

Sources for this page

Verify at the official NPI Registry.