NPIMap

Organization Active NPI

Open Door Community Health Centers

Doing business as Humboldt Open Door Clinic

  • Federally Qualified Health Center (FQHC)
  • Arcata, CA
National Provider Identifier
1255435533
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPEN DOOR COMMUNITY HEALTH CENTERS
Doing business as
Humboldt Open Door Clinic
Practice address
1150 Foster Ave
Arcata, CA 95521-5986
Phone
(707) 826-8610
Fax
(707) 826-8623
NPI assigned
Sep 8, 2006
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Victor Starr
Title
President/Ceo
Phone
(707) 826-8633

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Obstetrics Physician 207VX0000X

Addresses

Primary practice location

1150 Foster Ave
Arcata, CA 95521-5986

Mailing address

1275 8TH St
Arcata, CA 95521-5770
Phone (707) 826-8633

Other identifiers 1

IdentifierTypeStateIssuer
FHC03892FMedicaidCA

Other names 1

  • Humboldt Open Door Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040105000162 CA Part A Provider - Federally Qualified Health Center (FQHC) 9436067485 Practice locations: Arcata, CA
O20040414000890 CA Part B Supplier - Clinic/Group Practice 9436067485 Receives reassigned benefits from 211 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arcata, CA; Willow Creek, CA; McKinleyville, CA; Fortuna, CA; Ferndale, CA; Eureka, CA; Crescent City, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255435533. Details of each certification follow.

Federally qualified health center certification: CCN 051940

Legal name
OPEN DOOR COMMUNITY HEALTH CENTERS
Doing business as
HUMBOLDT OPEN DOOR CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1995
Last certification
Jan 1, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 18, 1971 in CA
Enrollment address
1150 Foster Ave
Arcata, CA 95521-5986

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
05D0612922Humboldt Open Door Clinic1150 Foster Ave, Arcata, CA 95521Provider-performed microscopyAug 27, 2026

National Provider Directory

National Provider Directory

Locations

1150 Foster Ave
Arcata, CA 95521
Phone (707) 822-2481

3798 Janes Rd
Ste 5
Arcata, CA 95521
Phone (707) 822-2273

2350 Buhne St
Ste A
Eureka, CA 95501
Phone (707) 443-4593

2412 Buhne St
Eureka, CA 95501
Phone (707) 441-1624

1644 Central Ave
Ste Af
McKinleyville, CA 95519
Phone (707) 839-3068

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Victor a Starr Individual Corporate OfficerPresident and Executive Officer Jan 7, 2020
W-2 Managing EmployeePresident and Executive Officer Jan 7, 2020
Jay Molofsky Individual Corporate DirectorBoard Member Aug 26, 2019
John Driscoll Individual Corporate DirectorBoard Member Jul 26, 2021
Lindsay Righter Individual Corporate DirectorBoard Member Jan 1, 2012
Sarah Kerr Individual Corporate OfficerVice President of Operations North Jun 5, 2015
W-2 Managing EmployeeVice President of Operations North Jun 5, 2015
Felicia Oldfather Individual Corporate DirectorBoard Treasurer Jan 1, 2002
Kathleen Moxon Individual Corporate DirectorBoard President Jul 1, 1999
Neal Sanders Individual Corporate DirectorBoard Member Jan 1, 1998
Stacy Watkins Individual Corporate DirectorDeputy Operations Director Dec 17, 2006
W-2 Managing Employee Dec 17, 2001
Sydney Fisher Larson Individual Corporate DirectorBoard Secretary Jul 1, 1999
Connie E Stewart Individual Corporate DirectorBoard Member Mar 1, 2009
Alison Talbot Individual Corporate DirectorBoard Vice President Jan 1, 2013

Practitioners & affiliated clinicians

Practitioners 120

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 120

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1255435533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 8TH ST",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955215770",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 FOSTER AVE",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955215986",
            "telephone_number": "707-826-8610",
            "fax_number": "707-826-8623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A",
        "authorized_official_last_name": "STARR",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "707-826-8633"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03892F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Humboldt Open Door Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Humboldt Open Door Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arcata, CA

Sources for this page

Verify at the official NPI Registry.