NPIMap

Organization Active NPI

Western Sierra Medical Clinic, Inc.

Doing business as Western Sierra Medical Clinic - Kings Beach

  • Federally Qualified Health Center (FQHC)
  • Kings Beach, CA
National Provider Identifier
1306324512
Registry record updated Mar 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WESTERN SIERRA MEDICAL CLINIC, INC.
Doing business as
Western Sierra Medical Clinic - Kings Beach
Practice address
8665 Salmon Avenue
Kings Beach, CA 96143
Phone
(530) 273-4984
Fax
(530) 273-4573
NPI assigned
Jul 31, 2018
Last updated
Mar 19, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
WESTERN SIERRA MEDICAL CLINIC, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2026

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

Authorized official

Name
Francine Novak
Title
Chief Planning and Development Offi
Phone
(530) 802-2706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

8665 Salmon Avenue
Kings Beach, CA 96143

Mailing address

844 Old Tunnel Rd Ste 110
Grass Valley, CA 95945-8524
Phone (530) 273-4984

Other identifiers 1

IdentifierTypeStateIssuer
1851513469MedicaidCA

Other names 1

  • Western Sierra Medical Clinic - Kings Beach Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306324512. Details of each certification follow.

  • CCN 921084 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921084

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WESTERN SIERRA MEDICAL CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2017
Last certification
Aug 8, 2017
Ownership / control type
For profit – corporation
Facility address
8665 Salmon Ave
Kings Beach, CA 96143

National Provider Directory

National Provider Directory
Tax ID family
Alex J Klistoff MD14 organizations share this tax ID, including this one
Part of
Alex J Klistoff MD

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773878400000",
    "number": "1306324512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "844 OLD TUNNEL RD STE 110",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959458524",
            "telephone_number": "530-273-4984",
            "fax_number": "530-273-4573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8665 SALMON AVENUE",
            "city": "KINGS BEACH",
            "state": "CA",
            "postal_code": "96143",
            "telephone_number": "530-273-4984",
            "fax_number": "530-273-4573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN SIERRA MEDICAL CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN SIERRA MEDICAL CLINIC, INC.",
        "enumeration_date": "2018-07-31",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A",
        "authorized_official_last_name": "NOVAK",
        "authorized_official_first_name": "FRANCINE",
        "authorized_official_title_or_position": "CHIEF PLANNING AND DEVELOPMENT OFFI",
        "authorized_official_telephone_number": "530-802-2706"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851513469",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Western Sierra Medical Clinic - Kings Beach",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Western Sierra Medical Clinic - Kings Beach",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kings Beach, CA

Sources for this page

Verify at the official NPI Registry.