Quartz Valley Indian Reservation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

QUARTZ VALLEY INDIAN RESERVATION

Doing business as

Anav Tribal Health Clinic

Practice address

9024 Sniktaw LN
Fort Jones, CA 96032-9408

Phone

(530) 468-4470

Fax

(530) 468-4478

NPI assigned

Apr 17, 2007

Last updated

Feb 4, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kyle Nelson, MSW, MPH

Title

Executive Director

Phone

(530) 468-4470

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ANAV TRIBAL HEALTH CLINIC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306062419. Details of each certification follow.

• CCN 051160 Federally qualified health center · Details

Federally qualified health center certification: CCN 051160

Legal name

QUARTZ VALLEY INDIAN RESERVATION

Doing business as

ANAV TRIBAL HEALTH CLINIC

Organization structure

OtherNon-profit

Enrollment address

9024 Sniktaw Lane
Fort Jones, CA 96032-9408

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 2

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

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.

• Amber Lee Hunter, FNP-C

  • Family Nurse Practitioner
  • Fort Jones, CA
  • NPI 1851168579
  Medicare reassignment NPD

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549238400000",
    "number": "1306062419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9024 SNIKTAW LN",
            "city": "FORT JONES",
            "state": "CA",
            "postal_code": "960329408",
            "telephone_number": "530-468-4470",
            "fax_number": "530-468-4478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9024 SNIKTAW LN",
            "city": "FORT JONES",
            "state": "CA",
            "postal_code": "960329408",
            "telephone_number": "530-468-4470",
            "fax_number": "530-468-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUARTZ VALLEY INDIAN RESERVATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2019-02-04",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "530-468-4470",
        "authorized_official_credential": "MSW, MPH"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306062419",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ANAV TRIBAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ANAV TRIBAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Douglas Scott Korcek, P.T.
• Laurie Jean Laquey, MFTI
• Marble Mountain Health
• Mark Grant Medinnus, DDS
• Kunjal R Patel
• Jacob S Rodgers
• Cynthia Victoria Samuel, RADT
• Scott Valley Physical Therapy and Fitness Center, PC
• Scott Valley Unified School District
• Brent Alan Webb, DDS

• Family Medicine Physician in Fort Jones, CA
• Providers in Fort Jones, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.