NPIMap

Organization Active NPI

Sutter Coast Hospital

Doing business as Sutter Coast Health Clinic @ Brookings-Harbor

  • Primary Care Clinic/Center
  • Brookings, OR
National Provider Identifier
1306853296
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SUTTER COAST HOSPITAL
Doing business as
Sutter Coast Health Clinic @ Brookings-Harbor
Practice address
555 5TH St
Brookings, OR 97415-9730
Phone
(541) 469-9205
Fax
(541) 469-9204
NPI assigned
Aug 2, 2006
Last updated
Oct 10, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
SUTTER COAST HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Mitch Hanna
Title
Ceo
Phone
(707) 464-8880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

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 names 1

  • Sutter Coast Health Clinic @ Brookings-Harbor Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507001230 OR Part B Supplier - Clinic/Group Practice 9436148111 Receives reassigned benefits from 6 practitioners
Practice locations: Brookings, OR

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2009628Sutter Coast Health Center at Brookings Harbor555 5TH St Suite 2, Brookings, OR 97415Certificate of waiverJul 7, 2028

National Provider Directory

National Provider Directory
Part of
Anthony Demory MD

Locations

555 5th St
Brookings, OR 97415
Phone (541) 469-9205

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Sutter Coast Health CenterCrescent City, CA, CCN 058519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 31, 1986

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1306853296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318359",
            "telephone_number": "707-464-8511",
            "fax_number": "707-464-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 5TH ST",
            "city": "BROOKINGS",
            "state": "OR",
            "postal_code": "974159730",
            "telephone_number": "541-469-9205",
            "fax_number": "541-469-9204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER COAST HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUTTER COAST HOSPITAL",
        "enumeration_date": "2006-08-02",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "MITCH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-464-8880"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter Coast Health Clinic @ Brookings-Harbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookings, OR

Sources for this page

Verify at the official NPI Registry.