NPIMap

Organization Active NPI

Prime Healthcare Services - Shasta LLC

  • General Acute Care Hospital
  • Redding, CA
National Provider Identifier
1205089026
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
230000023 Issued in CA
Legal business name
PRIME HEALTHCARE SERVICES - SHASTA LLC
Practice address
1100 Butte St
Redding, CA 96001-0852
Phone
(530) 244-8303
Fax
(530) 229-2811
NPI assigned
Oct 23, 2008
Last updated
Apr 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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

Authorized official

Name
Mr. Christopher Doan
Title
Chief Compliance Counsel
Phone
(909) 235-4307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 230000023 CA Primary

Addresses

Primary practice location

1100 Butte St
Redding, CA 96001-0852

Mailing address

12479 Central Ave
Chino, CA 91710-2670
Phone (909) 464-8896

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090218000243 CA Part A Provider - Hospital 7416012851 Practice locations: Redding, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205089026. Details of each certification follow.

Hospital certification: CCN 050764

Legal name
PRIME HEALTHCARE SERVICES - SHASTA LLC
Doing business as
SHASTA REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Mar 5, 2009
Last certification
Apr 7, 2023
Beds
246 (191 certified)
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Incorporated
Oct 2, 2008 in DE
Enrollment address
1100 Butte St
Redding, CA 96001-0852
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Shasta Regional Medical CenterCCN 050764 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Mohamad Itani Individual Corporate OfficerChief Executive Officer Sep 16, 2024
Corporate DirectorDirector Sep 16, 2024
W-2 Managing EmployeeChief Executive Officer Sep 16, 2024
Prime Healthcare Services, Inc Organization, Victorville, CA Corporation 5% Or Greater Direct Ownership Interest Nov 1, 2008 100%
Steven Aleman Individual OtherChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Aug 30, 2017

Facilities with the same owner 75

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

View all 75

Practitioners & affiliated clinicians

Affiliated clinicians 289

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

View all 289

NPI Registry JSON

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

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1205089026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12479 CENTRAL AVE",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917102670",
            "telephone_number": "909-464-8896",
            "fax_number": "909-464-8887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BUTTE ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010852",
            "telephone_number": "530-244-8303",
            "fax_number": "530-229-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - SHASTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-23",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE COUNSEL",
        "authorized_official_telephone_number": "909-235-4307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "230000023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.