NPIMap

Organization Active NPI

St. Joseph Health Northern California, LLC

Doing business as Providence Redwood Memorial Hospital

  • Critical Access Hospital
  • Fortuna, CA
National Provider Identifier
1285849026
Registry record updated Jun 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
110000173 Issued in CA
Legal business name
ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
Doing business as
Providence Redwood Memorial Hospital
Practice address
3300 Renner Dr
Fortuna, CA 95540
Phone
(707) 725-3361
Fax
(707) 725-7212
NPI assigned
May 14, 2007
Last updated
Jun 22, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. JOSEPH HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 22, 2021

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

Authorized official

Name
Donald Wayne Anderson
Title
Assistant Secretary for Enrollment
Phone
(425) 525-5392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 110000173 CA Primary

Addresses

Primary practice location

3300 Renner Dr
Fortuna, CA 95540

Mailing address

3300 Renner Dr
Fortuna, CA 95540-3120
Phone (707) 725-3361

Other names 1

  • Providence Redwood Memorial Hospital Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address marie.sorci@stjoe.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285849026. Details of each certification follow.

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
LLCNon-profit
Incorporated
Oct 27, 2016 in CA
Enrollment address
3300 Renner Dr
Fortuna, CA 95540-3120

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Providence Redwood Memorial HospitalCCN 051318 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
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 18

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

NameRoleSinceShare
James C Devore Individual Corporate DirectorBoard Member Oct 1, 2020
Oluyemi Adeyanju Individual Corporate OfficerVP, Sr Corporate Counsel Apr 1, 2018
Judith L Coffey Individual Corporate DirectorBoard Member May 26, 2021
Mary Bernadette McNulty Individual Corporate DirectorBoard Member Apr 1, 2018
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Oct 1, 2020
John Aryanpur Individual Corporate DirectorBoard Member Oct 1, 2020
Shelby D Arveson Individual Corporate OfficerCfo May 30, 2024
Michael Peter Keleman Individual W-2 Managing EmployeeChief Executive Jan 22, 2024
Conrad Hewitt Individual Corporate DirectorBoard Member Apr 1, 2018
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Apr 1, 2018
Keith Flamer Individual Corporate DirectorBoard Member Nov 28, 2023
Gregory David Hoffman Individual Corporate DirectorPresident/Ceo & Treasurer Oct 1, 2020
Jed Weissberg Individual Corporate DirectorBoard Member May 26, 2021
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Other Apr 1, 2018
Laureen T Driscoll Individual Corporate OfficerExecutive Officer Jan 25, 2022
Pamela a Kindig Individual Corporate DirectorBoard Member Oct 1, 2020
St Joseph Health Northern California LLC Organization, Irvine, CA LLC, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2018 100%
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Apr 1, 2018

Owners & managing parties with NPI records 11

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 101

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

View all 101

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624320000000",
    "number": "1285849026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 RENNER DR",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955403120",
            "telephone_number": "707-725-3361",
            "fax_number": "707-725-7212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 RENNER DR",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "95540",
            "telephone_number": "707-725-3361",
            "fax_number": "707-725-7212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JOSEPH HEALTH SYSTEM",
        "enumeration_date": "2007-05-14",
        "last_updated": "2021-06-22",
        "certification_date": "2021-06-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY FOR ENROLLMENT",
        "authorized_official_telephone_number": "425-525-5392"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "CA",
            "license": "110000173",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marie.sorci@stjoe.org",
            "affiliation": "N",
            "address_1": "3300 Renner Dr",
            "city": "Fortuna",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955403120",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Providence Redwood Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fortuna, CA

Sources for this page

Verify at the official NPI Registry.