NPIMap

Organization Active NPI

Glenn Medical Center, LLC

  • Medicare Defined Swing Bed Hospital Unit
  • Willows, CA
National Provider Identifier
1336187178
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
230000018 Issued in CA
Legal business name
GLENN MEDICAL CENTER, LLC
Practice address
1133 W Sycamore St
Willows, CA 95988-2601
Phone
(530) 934-1800
Fax
(530) 934-1818
NPI assigned
Jun 3, 2006
Last updated
Nov 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Authorized official

Name
Tammy Jean Thompson
Title
VP Finance/Cfo
Phone
(209) 287-6308

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 230000018 CA Primary
General Acute Care Hospital 282N00000X 230000018 CA

Addresses

Primary practice location

1133 W Sycamore St
Willows, CA 95988-2601

Mailing address

1133 W Sycamore St
Willows, CA 95988-2601
Phone (530) 934-1800

Other identifiers 1

IdentifierTypeStateIssuer
LTC30092FMedicaidCA

Other names 1

  • GLENN MEDICAL CENTER Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070705000269 CA Part B Supplier - Hospital Department(S) 3870505035 Receives reassigned benefits from 57 practitioners
Practice locations: Willows, CA
O20220725001330 CA Part A Provider - Critical Access Hospital 4486050838 1 other NPI on this enrollment
Practice locations: Willows, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336187178. Details of each certification follow.

Hospital certification: CCN 05Z306

Legal name
GLENN MEDICAL CENTER, LLC
Doing business as
GLENN MEDICAL CENTER
Organization structure
LLCProprietary
Incorporated
Aug 21, 2019 in CA
Enrollment address
1133 W Sycamore St
Willows, CA 95988-2601
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Glenn Medical Center 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 4

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

NameRoleSinceShare
Gurpreet Singh Randhawa Individual 5% Or Greater Direct Ownership InterestOwner/Member Jul 1, 2021 100%
W-2 Managing EmployeeOwner/Member Jul 1, 2021 100%
Shamsher Bhullar Individual Corporate OfficerAdministrator Jul 1, 2021
W-2 Managing EmployeeAdministrator Jul 1, 2021
Operational/Managerial ControlAdministrator Jul 1, 2021
Tammy Thompson Individual Corporate OfficerChief Financial Officer Jul 1, 2021
W-2 Managing EmployeeChief Financial Officer Jul 1, 2021
Operational/Managerial ControlChief Financial Officer Jul 1, 2021
Rumeet Kaur Randhawa Individual W-2 Managing EmployeeAssistant Administrator Jul 1, 2021
Operational/Managerial ControlAssistant Administrator Jul 1, 2021

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 68

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 68

Affiliated clinicians 1

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": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1336187178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 W SYCAMORE ST",
            "city": "WILLOWS",
            "state": "CA",
            "postal_code": "959882601",
            "telephone_number": "530-934-1800",
            "fax_number": "530-934-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 W SYCAMORE ST",
            "city": "WILLOWS",
            "state": "CA",
            "postal_code": "959882601",
            "telephone_number": "530-934-1800",
            "fax_number": "530-934-1818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "VP FINANCE/CFO",
        "authorized_official_telephone_number": "209-287-6308"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "CA",
            "license": "230000018",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "230000018",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC30092F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLENN MEDICAL CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "GLENN MEDICAL CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Willows, CA

Sources for this page

Verify at the official NPI Registry.