Norcal Healthconnect LLC
Organization Active NPI Critical Access Hospital · Healdsburg, CA
NPI 1295342012 · NPPES record last updated May 13, 2025
Key facts
- NPI
- 1295342012
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- NORCAL HEALTHCONNECT LLC
- Practice address
- 1375 University Ave
Healdsburg, CA 95448-3382 - Phone
- (707) 431-6500
- NPI assigned
- Sep 25, 2020
- Organization subpart
- No
Authorized official
- Name
- Donald W Anderson Jr.
- Title
- Assistant Secretary of Enrollments
- Phone
- (425) 358-9786
Owners & managing parties with NPI records 15
-
John Aryanpur, M.D.
Owned or controlled facilities with NPI records 4
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 3
Related certifications (CCN) 2
Facilities with the same owner 139
Practitioners 15
-
Stacy Nicolle Fekkers, LCSW
-
Shazah Khawaja, MD
-
Michael Thomas Bollinger, M.D.
-
David M. Young, MD
-
Francis W Cutruzzola, M.D.
-
Kevin R Deutsche, RPA-C
-
Joseph M Tito, MD
-
Alanna L Wargula, DPM
-
Bruce David Deas, MD
-
Shannon Lyn Manley, FNP-BC
-
Steven Peter Maron, M.D.
-
Anusuya Mokashi, M.D.
-
Peri Life Penman, D.O.
Affiliated clinicians 6
-
Samuel D Rose, MD
-
Mark Causin, MD
-
Candice Dolbier, D.O.
-
Amit Kumar Mehta, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Hospital certification: CCN 05Z321
- Legal name
- NORCAL HEALTHCONNECT LLC
- Doing business as
- HEALDSBURG HOSPITAL
- Organization structure
- LLC · Non-profit
- Enrollment address
- 1375 University Ave
Healdsburg, CA 95448-3382
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| James C Devore |
Corporate Director |
Jan 1, 2021 | |
| Oluyemi Adeyanju |
Corporate Officer |
Jan 1, 2021 | |
| Judith L Coffey |
Corporate Director |
May 26, 2021 | |
| Troy a Gideon |
W-2 Managing Employee |
Oct 20, 2023 | |
| Michelle Oxford |
W-2 Managing Employee |
May 1, 2024 | |
| Mary Bernadette McNulty |
Corporate Director |
Jan 1, 2021 | |
| Norcal Healthconnect LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2021 | 100% |
| Providence Health & Services - Washington |
Operational/Managerial Control | Jan 1, 2021 | |
| John Aryanpur |
Corporate Director |
Jan 1, 2021 | |
| Shelby D Arveson |
Corporate Officer |
May 30, 2024 | |
| Western Healthconnect |
Other | Jan 1, 2021 | |
| Conrad Hewitt |
Corporate Director |
Jan 1, 2021 | |
| Donald Wayne Anderson |
Corporate Officer |
Jan 1, 2021 | |
| Keith Flamer |
Corporate Director | Jan 23, 2024 | |
| Gregory David Hoffman |
Corporate Officer |
Jan 21, 2021 | |
| Nathan Reinert Husmann |
Corporate Officer |
Apr 28, 2023 | |
| Jed Weissberg |
Corporate Director |
May 26, 2021 | |
| St. Joseph Health System |
Operational/Managerial Control | Jan 1, 2021 | |
| Laureen T Driscoll |
Corporate Officer |
Jan 25, 2022 | |
| Bharatha B Naotunne |
W-2 Managing Employee |
Oct 17, 2022 | |
| Pamela a Kindig |
Corporate Director |
Jan 1, 2020 | |
| St Joseph Health Northern California LLC |
Operational/Managerial Control | Jan 1, 2021 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Petaluma Valley Hospital |
Hospital | 5% Or Greater Direct Ownership Interest | Jan 1, 2021 |
| Healdsburg Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2021 |
| Healdsburg Hospital |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201224000686 | CA | Part a Provider - Critical Access Hospital | 2466864038 |
Receives reassigned benefits from 2 practitioners Practice locations: Healdsburg, CA |
| O20210308001127 | CA | Part B Supplier - Clinic/Group Practice | 2466864038 |
Receives reassigned benefits from 34 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Healdsburg, CA; Petaluma, CA |
National Provider Directory
- Tax ID family
- Norcal Healthconnect LLC
Locations
1111 Sonoma Ave
Santa Rosa, CA 95405
Phone (707) 528-2065
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | |||
| Critical Access Hospital | 282NC0060X | Yes |
Addresses
Primary practice location
1375 University Ave
Healdsburg, CA 95448-3382
Mailing address
PO Box 31001-3085
Pasadena, CA 91110-3085
Other names
- HEALDSBURG HOSPITAL
Other providers in Healdsburg, CA
- Christine Naber
- Michael W. Neal
- Thomas Alan Neal
- Kathleen Ann Nichols
- Norcal Healthconnect LLC
- Norcal Healthconnect LLC
- Norcal Healthconnect LLC
- Ashley Norris
- North Bay Eye Associates, a Medical Corporation
- North Coast Faculty Medical Group
All providers in Healdsburg, 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 May 13, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.