NPIMap

Organization Active NPI

Ukiah Adventist Hospital

Doing business as Adventist Health Ukiah Valley

  • General Acute Care Hospital
  • Ukiah, CA
National Provider Identifier
1235120676
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
110000095 Issued in CA
Legal business name
UKIAH ADVENTIST HOSPITAL
Doing business as
Adventist Health Ukiah Valley
Practice address
275 Hospital Dr
Ukiah, CA 95482-4531
Phone
(707) 463-7360
Fax
(707) 463-7689
NPI assigned
Nov 3, 2005
Last updated
Jul 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Authorized official

Name
Mr. Eric Stevens
Title
President
Phone
(707) 456-3010

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X
Diagnostic Radiology Physician 2085R0202X
General Acute Care Hospital 282N00000X 110000095 CA Primary

Addresses

Primary practice location

275 Hospital Dr
Ukiah, CA 95482-4531

Mailing address

PO Box 888867
Los Angeles, CA 90088-8867

Other identifiers 10

IdentifierTypeStateIssuer
HSP40301FMedicaidCA
005433002OtherCAKAISER
ZZR00301FMedicaidCA
ZZZ18251ZOtherCABLUE SHIELD
050301OtherCABLUE CROSS
ZZZ92403ZOtherCABLUE SHIELD
195519900OtherCAUS DEPARTMENT OF LABOR
ZZZ13334ZOtherCABLUE SHIELD
ZZZC2307ZOtherCABLUE SHIELD
ZZZC2308ZOtherCABLUE SHIELD

Other names 1

  • Adventist Health Ukiah Valley Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041015000818 CA Part B Supplier - Clinic/Group Practice 6406816123 Receives reassigned benefits from 197 practitioners
Practice locations: Ukiah, CA
O20080108000652 CA Part A Provider - Hospital 6406816123 Practice locations: Ukiah, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235120676. Details of each certification follow.

Hospital certification: CCN 050301

Legal name
UKIAH ADVENTIST HOSPITAL
Doing business as
ADVENTIST HEALTH UKIAH VALLEY
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 18, 2025
Beds
127 (111 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jan 25, 1967 in CA
Enrollment address
275 Hospital Dr
Ukiah, CA 95482-4531
Other Hospital Practice Location
Hospital subgroups
General, Acute care, Other

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

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Adventist Health Ukiah ValleyCCN 050301 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

11411 Brookshire Ave
Ste 207
Downey, CA 90241
Phone (562) 904-4411

475 N Forbes St
Lakeport, CA 95453
Phone (707) 263-6346

901 Dover Dr
Ste 126
Newport Beach, CA 92660
Phone (949) 873-5089

1165 S Dora St
Ste D1
Ukiah, CA 95482
Phone (707) 468-9335

246 Hospital Dr
Ukiah, CA 95482
Phone (707) 462-1928

260 Hospital Dr
Ste 101
Ukiah, CA 95482
Phone (707) 463-7428

487 S Main St
Ukiah, CA 95482

721 S Dora St
Ukiah, CA 95482
Phone (707) 367-8430

844 S Dora St
Ukiah, CA 95482
Phone (707) 462-8603

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Kerry L Heinrich Individual Corporate OfficerChair Jan 1, 2022
Corporate DirectorBoard Member Dec 15, 2014
John H Cress Individual Corporate OfficerBoard Member Oct 1, 2024
Meredith S Jobe Individual Corporate OfficerSecretary Mar 31, 2014
Eric a Stevens Individual Corporate OfficerInterim President Jul 8, 2024
W-2 Managing Employee Jul 8, 2024
Richard K Reiner Individual Corporate DirectorBoard Member Jan 16, 2017
Joy a. Fehr Individual Corporate DirectorBoard Member Oct 1, 2020
Jonathan J Daggett Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew R Davis Individual Corporate DirectorBoard Member May 5, 2017
Todd N Hofheins Individual Corporate OfficerVice Chair Jan 24, 2022
Ann K Beckett Individual Corporate DirectorBoard Member Jan 1, 2024
Marc K Woodson Individual Corporate DirectorBoard Member Jan 1, 2019
John C Freedman Individual Corporate DirectorBoard Member Sep 26, 2016
Jeffrey R Mock Individual Corporate OfficerTreasurer Sep 18, 2023
Jack W Wagner Individual Corporate DirectorBoard Member Dec 1, 2022
Kenneth Jutzy Individual Corporate DirectorBoard Member Jan 1, 2024
Bradford C Newton Individual Corporate DirectorBoard Member Aug 16, 2021
Robert a Cherry Individual Corporate DirectorBoard Member May 5, 2017
Larry L Innocent Individual Corporate DirectorBoard Member Sep 19, 2011
Adventist Health System/West Organization, Roseville, CA Corporation, Non-profit Operational/Managerial Control Jun 16, 1980 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 105

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

View all 105

Practitioners & affiliated clinicians

Practitioners 241

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 241

Affiliated clinicians 498

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

View all 498

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752710400000",
    "number": "1235120676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888867",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900888867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 HOSPITAL DR",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824531",
            "telephone_number": "707-463-7360",
            "fax_number": "707-463-7689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UKIAH ADVENTIST HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-456-3010",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "110000095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40301F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "005433002",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR00301F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ18251Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "050301",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ92403Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPARTMENT OF LABOR",
            "identifier": "195519900",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ13334Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZC2307Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZC2308Z",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "275 Hospital Dr",
            "city": "Ukiah",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954824531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Adventist Health Ukiah Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ukiah, CA

Sources for this page

Verify at the official NPI Registry.