Last Frontier Healthcare District
Organization Active NPI Rural Health Clinic/Center · Canby, CA
NPI 1376164749 · NPPES record last updated Dec 28, 2022
Key facts
- NPI
- 1376164749
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- LAST FRONTIER HEALTHCARE DISTRICT
- Practice address
- 670 County Road 83
Canby, CA 96015-9722 - Phone
- (530) 233-4641
- Fax
- (530) 233-2830
- NPI assigned
- Apr 27, 2020
- Organization subpart
- No
Authorized official
- Name
- Kevin Scott Kramer
- Title
- Chief Executive Officer
- Phone
- (530) 708-8801
Owners & managing parties with NPI records 5
-
Edward Paul Richert, M.D.
Owned or controlled facilities with NPI records 3
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 1
Related certifications (CCN) 2
Change of ownership 1
Facilities with the same owner 3
Practitioners 33
-
James Eric Appel, MD
-
Virginia Baker, FNP-C
-
Lisanne Ryner Burkholder, MD FACP FRACP
-
Heather Marie Caldwell, PA-C
-
Kathleen B. Chesney, PAC
-
Joseph Esherick, M.D.
-
Alex Ferber, PA-C
-
James John Helmer Jr., M.D.
-
Matthew Kappen, M.D.
-
Jacee D Knighton, FNP-C
-
Jay Lai, M.D.
-
Raymond P Mandel, PHD
-
Thomas C. Mitchell, P.A.
-
Ruth Ann Moeller, FNP
-
Marina Morie, M.D.
-
Yohan Perera, MD
-
Tony L. Reynolds, NP-C
-
Wendy Marie Richardson, PA-C
-
Edward Paul Richert, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0644248 | Last Frontier Healthcare District | Certificate of waiver | Sep 2, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Rural health clinic certification: CCN 058714
- Legal name
- LAST FRONTIER HEALTHCARE DISTRICT
- Doing business as
- CANBY FAMILY PRACTICE CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 1, 2020
- Last certification
- Mar 3, 2020
- Ownership / control type
- 2B
- Organization structure
- Government · Non-profit
- Enrollment address
- 670 County Road 83
Canby, CA 96015-9722 - Related CCNs
- 051330
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Carol a Madison |
Corporate Director |
Jan 9, 2013 | |
| Edward J Johnson |
Corporate Officer |
Feb 11, 2019 | |
| Last Frontier Healthcare District |
5% Or Greater Direct Ownership Interest | Jul 1, 2020 | 100% |
| Kevin Kramer |
Corporate Officer |
Jul 20, 2013 | |
| W-2 Managing Employee |
May 28, 2020 | ||
| Rose Boulade |
Corporate Director |
Jan 1, 2026 | |
| Patrick J Fields |
Corporate Officer |
Jul 14, 2019 | |
| W-2 Managing Employee |
Jul 1, 2020 | ||
| Edward P Richert |
Corporate Officer |
Jun 1, 2012 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| Modoc Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest | Oct 12, 2010 |
| Modoc Medical Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | May 16, 2008 |
| Last Frontier Healthcare District |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Aug 23, 2011 Jan 1, 2010 Jan 1, 2010 |
| Modoc Medical Center Family Practice Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) | Aug 23, 2011 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jul 1, 2020 | Change of Ownership |
Canby Family Practice Clinic |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200622000712 | CA | Part a Provider - Rural Health Clinic | 2466447412 | Practice locations: Canby, CA |
National Provider Directory
- Tax ID family
- Modoc Medical Ctr
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
670 County Road 83
Canby, CA 96015-9722
Mailing address
PO Box 190
Alturas, CA 96101-0190
Phone (530) 708-8801
Other practice location 1
670 County Road 83
Canby, CA 96015-9722
Phone (530) 233-4641
Other names
- Canby Family Practice Clinic
Other providers in Canby, CA
- Joey Chou-Yie Chen
- Mickey Cole
- Virginia L Hassler
- I'Sot Inc
- Lake Health District
- Raymond P Mandel
- Wendy Marie Richardson
All providers in Canby, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 28, 2022. 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.