NPIMap

Organization Active NPI

Norcal Healthconnect LLC

Doing business as Healdsburg Hospital

  • Critical Access Hospital
  • Healdsburg, CA
National Provider Identifier
1295342012
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
NORCAL HEALTHCONNECT LLC
Doing business as
Healdsburg Hospital
Practice address
1375 University Ave
Healdsburg, CA 95448-3382
Phone
(707) 431-6500
NPI assigned
Sep 25, 2020
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

1375 University Ave
Healdsburg, CA 95448-3382

Mailing address

PO Box 31001-3085
Pasadena, CA 91110-3085

Other names 1

  • HEALDSBURG HOSPITAL Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295342012. Details of each certification follow.

Hospital certification: CCN 05Z321

Legal name
NORCAL HEALTHCONNECT LLC
Doing business as
HEALDSBURG HOSPITAL
Organization structure
LLCNon-profit
Enrollment address
1375 University Ave
Healdsburg, CA 95448-3382
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Norcal Healthconnect LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

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 DirectorMember, Board of Managers Jan 1, 2021
Oluyemi Adeyanju Individual Corporate OfficerCorporate Secretary Jan 1, 2021
Judith L Coffey Individual Corporate DirectorMember, Board of Managers May 26, 2021
Troy a Gideon Individual W-2 Managing EmployeeAd; Oct 20, 2023
Michelle Oxford Individual W-2 Managing EmployeeAd; May 1, 2024
Mary Bernadette McNulty Individual Corporate DirectorMember, Board of Managers Jan 1, 2021
Norcal Healthconnect LLC Organization, Santa Rosa, CA Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jan 1, 2021 100%
Providence Health & Services - Washington Organization, Renton, WA Corporation Operational/Managerial Control Jan 1, 2021
John Aryanpur Individual Corporate DirectorMember, Board of Managers Jan 1, 2021
Shelby D Arveson Individual Corporate OfficerCfo May 30, 2024
Western Healthconnect Organization, Renton, WA Corporation Other Jan 1, 2021
Conrad Hewitt Individual Corporate DirectorMember, Board of Directors Jan 1, 2021
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary for Enrollme Jan 1, 2021
Keith Flamer Individual Corporate Director Jan 23, 2024
Gregory David Hoffman Individual Corporate OfficerChief Executive/President Jan 21, 2021
Nathan Reinert Husmann Individual Corporate OfficerTreasurer Apr 28, 2023
Jed Weissberg Individual Corporate DirectorMember, Board of Managers May 26, 2021
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Operational/Managerial Control Jan 1, 2021
Laureen T Driscoll Individual Corporate OfficerRegional Ceo Jan 25, 2022
Bharatha B Naotunne Individual W-2 Managing EmployeeFinancial Executive Oct 17, 2022
Pamela a Kindig Individual Corporate DirectorMember, Board of Managers Jan 1, 2020
St Joseph Health Northern California LLC Organization, Irvine, CA LLC Operational/Managerial Control Jan 1, 2021

Owners & managing parties with NPI records 15

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

View all 15

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Petaluma Valley HospitalPetaluma, CA, CCN 050136 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2021
Healdsburg HospitalHealdsburg, CA, CCN 051321 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2021
Healdsburg HospitalHealdsburg, CA, CCN 555590 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2021

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 139

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 139

Practitioners & affiliated clinicians

Practitioners 9

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 5

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

NPI Registry JSON

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1295342012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-3085",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911103085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 UNIVERSITY AVE",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954483382",
            "telephone_number": "707-431-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORCAL HEALTHCONNECT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-25",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEALDSBURG HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HEALDSBURG HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Healdsburg, CA

Sources for this page

Verify at the official NPI Registry.