Sutter Coast Hospital
Organization Active NPI Primary Care Clinic/Center · Brookings, OR
NPI 1306853296 · NPPES record last updated Oct 10, 2016
Key facts
- NPI
- 1306853296
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- SUTTER COAST HOSPITAL
- Practice address
- 555 5TH St
Brookings, OR 97415-9730 - Phone
- (541) 469-9205
- Fax
- (541) 469-9204
- NPI assigned
- Aug 2, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- SUTTER COAST HOSPITAL
Authorized official
- Name
- Mitch Hanna
- Title
- Ceo
- Phone
- (707) 464-8880
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 5
Practitioners 39
-
Juliane Leighton, MD
-
Adour Richard Adrouny, M.D.
-
Robin Lee Zagone, M.D.
-
Monique Schwartz, D.O.
-
Karen G Chase, FNP RN
-
Daniel Alekyan, DO
-
Micah Diaz Berry, M.D.
-
Lynne A Bui, M.D.
-
Ram K Chillar, M.D.
-
Jesyka D. L. Garlich, PA-C
-
Elie M Hobeika, MD
-
Adam M Holleran, M.D.
-
May Chien-Shian Hong, M.D.
-
Vincent Lee Huntley, APRN
-
Robert A Jason, DO
-
Albert A. McClain Jr., M. D.
-
Sheldon Meshulam, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 38D2009628 | Sutter Coast Health Center at Brookings Harbor | Certificate of waiver | Jul 7, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Sutter Coast Health Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Jan 31, 1986 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040507001230 | OR | Part B Supplier - Clinic/Group Practice | 9436148111 |
Receives reassigned benefits from 6 practitioners Practice locations: Brookings, OR |
National Provider Directory
- Part of
- Sutter Urgent Care Clin
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
555 5TH St
Brookings, OR 97415-9730
Mailing address
800 E Washington Blvd
Crescent City, CA 95531-8359
Phone (707) 464-8511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 840162000 | Other | OR | BX REGENCE |
| 227691 | Medicaid | OR | |
| CT3220 | Other | RAILROAD RETIRE |
Other names
- Sutter Coast Health Clinic @ Brookings-Harbor
Other providers in Brookings, OR
- Statewide Meditrans
- Sarah B Stewart
- Hollie Anne Strahm
- Stephanie Stringham
- Sunlight Family Center, LLC
- The Evangelical Lutheran Good Samaritan Society
- Thomas Joseph Martinelli MD a Professional Corp
- Garrett Tovey
- Mary Anne Trailor
- Leanne Trentman
All providers in Brookings, OR · Primary Care Clinic/Center in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 10, 2016. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.