NPIMap

Organization Active NPI

Sutter Bay Hospitals

  • Clinic/Center
  • Lakeport, CA
National Provider Identifier
1356779797
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SUTTER BAY HOSPITALS
Practice address
5196 Hill Rd E
Suite 300
Lakeport, CA 95453-6360
Phone
(707) 263-6885
Fax
(707) 263-6624
NPI assigned
Oct 22, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
John B. Gates
Title
Cfo
Phone
(510) 450-7357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

5196 Hill Rd E
Suite 300
Lakeport, CA 95453-6360

Mailing address

2000 Powell St. 10TH FL
Emeryville, CA 94608-1804
Phone (510) 450-7347

Other names 1

  • Sutter Bay West Hospitals Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050517000547 CA Part B Supplier - Clinic/Group Practice 3476506528 Receives reassigned benefits from 144 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Castro Valley, CA; Santa Rosa, CA; San Leandro, CA; San Francisco, CA; Oakland, CA; Lakeport, CA; Berkeley, CA; Burlingame, CA…
O20131121001956 CA Part A Provider - Rural Health Clinic 3476506528 Practice locations: Lakeport, CA

Rural health clinic certification: CCN 058980

Legal name
SUTTER BAY HOSPITALS
Doing business as
SUTTER LAKESIDE COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 14, 2014
Last certification
Apr 14, 2014
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1885 in CA
Enrollment address
5196 Hill Rd E
Ste 300
Lakeport, CA 95453-6374

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 12

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

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
05D2076656Sutter Lakeside Community Clinic5196 Hill Rd E Ste 300, Lakeport, CA 95453Provider-performed microscopyOct 5, 2027

National Provider Directory

National Provider Directory

Locations

5196 Hill Rd E
Lakeport, CA 95453
Phone (707) 263-4108

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Dennis J O'Connell Individual Corporate DirectorBoard Member Jan 1, 2010
David K Black Individual Corporate DirectorBoard Member May 20, 2015
Diana L Bell Individual Corporate DirectorBoard Member May 20, 2015
Karen a Hall Individual Corporate OfficerSecretary May 20, 2015
John B Gates Individual Corporate OfficerCfo Jan 1, 2013
W-2 Managing Employee Jan 1, 2010
Jane C Varner Individual Corporate DirectorBoard Member Jan 1, 2019
Katherine T Hsiao Individual Corporate DirectorBoard Member Jan 1, 2014
Eric a Flowers Individual Corporate DirectorBoard Member May 20, 2015
Jill M Kacher Cobb Individual Corporate DirectorBoard Member Jan 1, 2019
Theodore Deikel Individual Corporate DirectorBoard Member Jan 1, 2010
James E Conforti Individual Corporate OfficerAssistant Secretary Mar 12, 2012
Corporate DirectorBoard Member Mar 12, 2012
Richard M Levy Individual Corporate DirectorBoard Member May 20, 2015
Ronesh Sinha Individual Corporate DirectorBoard Member May 20, 2015
John F Ryan Individual Corporate DirectorBoard Member May 20, 2015
Emil R Eisenhardt Individual Corporate DirectorBoard Member Aug 5, 2009
Margaret a Taylor Individual Corporate DirectorBoard Member May 20, 2015
Sarah Krevans Individual Corporate DirectorBoard Member Jun 21, 2012
Henry Yu Individual Corporate Officer Jun 9, 2023
W-2 Managing Employee Jun 9, 2023
Umesh V Padval Individual Corporate DirectorBoard Member Jan 1, 2019
Anthony G Wagner Individual Corporate DirectorBoard Member May 20, 2015
Richard C Hill Individual Corporate DirectorBoard Member May 20, 2015
Elizabeth M Vilardo Individual Corporate DirectorBoard Member Jan 1, 2019
Sutter Health Organization, Sacramento, CA Non-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2014 100%
Steven H Oliver Individual Corporate DirectorBoard Member Jan 1, 2010

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Sutter Lakeside HospitalLakeport, CA, CCN 051329 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2010
California Pacific Medical Center - Davies CampusSan Francisco, CA, CCN 056245 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 59

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 59

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1356779797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 POWELL ST. 10TH FL",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081804",
            "telephone_number": "510-450-7347",
            "fax_number": "510-450-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5196 HILL RD E",
            "address_2": "SUITE 300",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954536360",
            "telephone_number": "707-263-6885",
            "fax_number": "707-263-6624"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER BAY HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-22",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "GATES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "510-450-7357"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter Bay West Hospitals",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sutter Bay West Hospitals",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lakeport, CA

Sources for this page

Verify at the official NPI Registry.