Coastal Health Alliance

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

COASTAL HEALTH ALLIANCE

Doing business as

Point Reyes Medical Clinic

Practice address

503 B Street
Point Reyes Station, CA 94956

Phone

(415) 663-8666

Fax

(415) 663-9532

NPI assigned

Feb 12, 2015

Last updated

Feb 12, 2015By 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

Mr. Steven P Siegel

Title

Executive Director

Phone

(415) 663-8781

Specialties & licenses 1

Addresses

Other names 1

• Point Reyes Medical Clinic Doing business as

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 1356732325. Details of each certification follow.

• CCN 751146 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 751146

Legal name

COASTAL HEALTH ALLIANCE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 6, 2015

Last certification

Mar 6, 2015

Ownership / control type

Non-profit – church related

Facility address

503 B Street
Point Reyes Station, CA 94956

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

{
    "created_epoch": "1423699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423699200000",
    "number": "1356732325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 910",
            "city": "POINT REYES STATION",
            "state": "CA",
            "postal_code": "949560910",
            "telephone_number": "415-663-8781",
            "fax_number": "415-663-9632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 B STREET",
            "city": "POINT REYES STATION",
            "state": "CA",
            "postal_code": "94956",
            "telephone_number": "415-663-8666",
            "fax_number": "415-663-9532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL HEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-12",
        "last_updated": "2015-02-12",
        "status": "A",
        "authorized_official_last_name": "SIEGEL",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "415-663-8781",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Point Reyes Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Zsuzsanna Biran, R.PH.
• Ramiro Campos
• Carolyn Ruth Chase, RN, NP
• Ellen M. Christiansen, MSN, FNP
• Coastal Health Alliance (Point Reyes Medical Clinic)
• Coastal Health Alliance
• Colin Hamblin, a Professional Medical Corporation
• County of Marin
• Craig Douglas Crispin, D.D.S.
• Kathie Marie Dalessandri, M.D.

• Federally Qualified Health Center (FQHC) in Point Reyes Station, CA
• Providers in Point Reyes Station, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2015; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.