Willow Creek - Six Rivers Medical Center

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

WILLOW CREEK - SIX RIVERS MEDICAL CENTER

Practice address

850 State Hwy 96
Willow Creek, CA 95573

Phone

(530) 629-3777

Fax

(530) 629-2866

NPI assigned

Jun 26, 2006

Last updated

Sep 20, 2019By 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

Douglas Allen Shaw

Title

Chief Executive Officer

Phone

(707) 822-7220

Specialties & licenses 1

Addresses

Other identifiers 4

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• American Hospital Management Corporation

  dba Mad River Community Hospital

  • Rural Health Clinic/Center
  • Arcata, CA
  • NPI 1609979707

  Member Of

  NPD member

Practitioners 4

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.

• Kimberly Ann Hall, LCSW/LMSW

  • Social Worker
  • Arcata, CA
  • NPI 1013338698
  NPD
• Alison Marie Palacios, D.O.

  • Family Medicine Physician
  • Arcata, CA
  • NPI 1265708424
  NPD (past)
• Jennifer Dawn Dawson, D.O.

  • Family Medicine Physician
  • Hermitage, PA
  • NPI 1659451185
  NPD (past)
• Judd Walter Dawson, D.O.

  • Family Medicine Physician
  • Hermitage, PA
  • NPI 1457431991
  NPD (past)

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1376570473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 4388",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955184388",
            "telephone_number": "707-822-7220",
            "fax_number": "707-826-8258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 STATE HWY 96",
            "city": "WILLOW CREEK",
            "state": "CA",
            "postal_code": "95573",
            "telephone_number": "530-629-3777",
            "fax_number": "530-629-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK - SIX RIVERS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-822-7220"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "55-3980",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PACT PROVIDER #",
            "identifier": "HAP10028F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "ZZZ33943Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM10028F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judi G Nelson, P.T.
• Open Door Community Health Centers (Willow Creek Community Health Center)
• Michael Noel Sonn
• Trinity River Cab
• Thomas Weisend, RN
• Willow Creek Pharmacy Inc (willow creek pharmacy)
• Willow Creek Youth Partnership

• Rural Health Clinic/Center in Willow Creek, CA
• Providers in Willow Creek, CA by specialty
• Rural Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.