NPIMap

Organization Active NPI

Peach Tree Healthcare

Doing business as Peach Tree North Sacramento II

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1245043413
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEACH TREE HEALTHCARE
Doing business as
Peach Tree North Sacramento II
Practice address
3840 Rosin CT Ste 150
Sacramento, CA 95834-1699
Phone
(530) 749-3242
Fax
(530) 743-5044
NPI assigned
Jan 30, 2025
Last updated
Jan 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Authorized official

Name
Michelle Woodard
Title
Ceo
Phone
(530) 749-3242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3840 Rosin CT Ste 150
Sacramento, CA 95834-1699

Mailing address

1114 Yuba St Ste 220
Marysville, CA 95901-4838
Phone (530) 749-3242

Other names 1

  • Peach Tree North Sacramento II Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250331001099 CA Part A Provider - Federally Qualified Health Center (FQHC) 7416978440 Practice locations: Sacramento, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245043413. Details of each certification follow.

Federally qualified health center certification: CCN A01942

Legal name
PEACH TREE HEALTHCARE
Doing business as
PEACH TREE NORTH SACRAMENTO II
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 19, 2025
Last certification
Mar 19, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
3840 Rosin CT
Ste 150
Sacramento, CA 95834-1699

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Peach Tree Healthcare10 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

2675 Apricot St
Live Oak, CA 95953
Phone (530) 695-0700

1114 Yuba St
Ste 220
Marysville, CA 95901
Phone (240) 816-4358

120 5th St
Rm 1
Marysville, CA 95901

710 4th St
#G
Marysville, CA 95901
Phone (530) 749-4556

724 5th St
Marysville, CA 95901
Phone (530) 743-7413

4446 Olive Ave
Bldg P5
Olivehurst, CA 95961

477 Ainsley Ave
Yuba City, CA 95991
Phone (530) 673-1935

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Veronica Avila Individual W-2 Managing EmployeeController Jun 1, 2004
Leanne Link Individual Corporate DirectorBoard Secretary/Treasurer Mar 27, 2025
Robert Bendorf Individual Corporate DirectorBoard Vice Chair Jul 25, 2024
Emilio Flores Individual Corporate DirectorBoard Member Oct 9, 2025
Monika Lee Individual Corporate DirectorBoard Member Aug 29, 2024
Michelle Woodard Individual Corporate OfficerCoo Jun 1, 2016
Ngoc-Phuong T Luu Individual Corporate DirectorBoard Member Apr 1, 2020
Renick House Individual Corporate DirectorBoard Member Feb 27, 2025
Chundeep Sidhu Individual Corporate DirectorBoard Member Sep 25, 2025
Tracie Riggs Individual Corporate OfficerCeo Feb 27, 2025
Gregory Barker Individual Corporate OfficerCfo Mar 13, 2025
Erika Laine Summers Individual Corporate DirectorBoard Chair Jul 1, 2020
Awni Allababidi Individual Corporate DirectorBoard Chair Oct 1, 2017
Edward Anthony Kalpas Individual Corporate OfficerCmo Nov 10, 2025
Donald Blaser Individual Corporate DirectorBoard Member Feb 1, 2021

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 2

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

FacilityTypeRoleSince
Peach Tree North SacramentoSacramento, CA, CCN 751916 Federally qualified health center Operational/Managerial Control Jul 10, 2012
Peach Tree HealthcareYuba City, CA, CCN 921009 Federally qualified health center Operational/Managerial Control Feb 1, 2017

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 60

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 60

NPI Registry JSON

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

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1245043413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 YUBA ST STE 220",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959014838",
            "telephone_number": "530-749-3242",
            "fax_number": "530-743-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 ROSIN CT STE 150",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341699",
            "telephone_number": "530-749-3242",
            "fax_number": "530-743-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH TREE HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-30",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-749-3242"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach Tree North Sacramento II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.