St. Joseph Health Northern California, LLC
Organization Active NPI Critical Access Hospital · Fortuna, CA
NPI 1285849026 · NPPES record last updated Jun 22, 2021
Key facts
- NPI
- 1285849026
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 110000173 (CA)
- Legal business name
- ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
- Practice address
- 3300 Renner Dr
Fortuna, CA 95540 - Phone
- (707) 725-3361
- Fax
- (707) 725-7212
- NPI assigned
- May 14, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- ST. JOSEPH HEALTH SYSTEM
Authorized official
- Name
- Donald Wayne Anderson
- Title
- Assistant Secretary for Enrollment
- Phone
- (425) 525-5392
Owners & managing parties with NPI records 11
-
John Aryanpur, M.D.
Other NPIs on the same Medicare enrollment 1
Related certifications (CCN) 2
Practitioners 1
-
Ronald Bevan Jones, M.D.
Affiliated clinicians 101
-
Abdul Said Fazel Abdali, M.D.
-
Deji Akinlosotu, CRNA
-
Gregory Barkdull, MD
-
Sarah Darlene Beach, FNP
-
Emily R Berg, CRNA
-
Brandon Eugene Bireley, D.O.
-
Tin C. Botzler, MD
-
Gerald Stewart Buntin, M.D.
-
Weiling Chang, M.D.
-
Danielle Leighann Cole, NP-C
-
Khaldoun A Debian, M.D.
-
Ali Deyhim, DPM
-
Barry S Donner, MD
-
Rachel Donohue, MD
Medicare Care Compare: Hospital
- Listed as
- Providence Redwood Memorial Hospital
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Hospital certification: CCN 051318
- Legal name
- ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC
- Doing business as
- PROVIDENCE REDWOOD MEMORIAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Aug 1, 2005
- Last certification
- May 5, 2023
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Most recent change of ownership
- Apr 1, 2018 (1 total)
- Organization structure
- LLC · Non-profit
- Incorporated
- Oct 27, 2016 in CA
- Enrollment address
- 3300 Renner Dr
Fortuna, CA 95540-3120
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| James C Devore |
Corporate Director |
Oct 1, 2020 | |
| Oluyemi Adeyanju |
Corporate Officer |
Apr 1, 2018 | |
| Judith L Coffey |
Corporate Director |
May 26, 2021 | |
| Mary Bernadette McNulty |
Corporate Director |
Apr 1, 2018 | |
| Providence Health & Services - Washington |
Operational/Managerial Control | Oct 1, 2020 | |
| John Aryanpur |
Corporate Director |
Oct 1, 2020 | |
| Shelby D Arveson |
Corporate Officer |
May 30, 2024 | |
| Michael Peter Keleman |
W-2 Managing Employee |
Jan 22, 2024 | |
| Conrad Hewitt |
Corporate Director |
Apr 1, 2018 | |
| Donald Wayne Anderson |
Corporate Officer |
Apr 1, 2018 | |
| Keith Flamer |
Corporate Director |
Nov 28, 2023 | |
| Gregory David Hoffman |
Corporate Director |
Oct 1, 2020 | |
| Jed Weissberg |
Corporate Director |
May 26, 2021 | |
| St. Joseph Health System |
Other | Apr 1, 2018 | |
| Laureen T Driscoll |
Corporate Officer |
Jan 25, 2022 | |
| Pamela a Kindig |
Corporate Director |
Oct 1, 2020 | |
| St Joseph Health Northern California LLC |
5% Or Greater Direct Ownership Interest | Apr 1, 2018 | 100% |
| Providence St. Joseph Health |
Other | Apr 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180213001383 | CA | Part a Provider - Critical Access Hospital | 8921374562 |
Receives reassigned benefits from 5 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fortuna, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 110000173 | CA | Yes |
Addresses
Primary practice location
3300 Renner Dr
Fortuna, CA 95540
Mailing address
3300 Renner Dr
Fortuna, CA 95540-3120
Phone (707) 725-3361
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285849026 | Medicaid | CA |
Other names
- Providence Redwood Memorial Hospital
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | marie.sorci@stjoe.org |
Other providers in Fortuna, CA
- Adriane St. Clare
- St. Joseph Health Northern California, LLC
- St. Joseph Health Northern California, LLC
- St. Joseph Health Northern California, LLC
- St. Joseph Health Northern California, LLC
- St. Luke Healthcare and Rehabilitation Center
- Mary Ellen Stewart
- Nancy Stinson Lollich
- Stephanie Ivy Stone
- Strehl'S Family Shoes & Repair
All providers in Fortuna, CA · Critical Access Hospital in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.