NPIMap

Organization Active NPI

Redding Rancheria

  • Federally Qualified Health Center (FQHC)
  • Weaverville, CA
National Provider Identifier
1386164580
Registry record updated Jun 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REDDING RANCHERIA
Practice address
81 Arbuckle Court
Weaverville, CA 96093
Phone
(530) 623-0021
Fax
(530) 623-0025
NPI assigned
Jun 20, 2017
Organization subpart
Yes
Parent organization
REDDING RANCHERIAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 1, 2022

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

Authorized official

Name
Mrs. Lori Hernandez
Title
Administrator
Phone
(530) 226-1740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

81 Arbuckle Court
Weaverville, CA 96093

Mailing address

1441 Liberty St
Redding, CA 96001-0811
Phone (530) 224-2700

Other practice location 1

31660 Hwy 3
Weaverville, CA 96093
Phone (530) 623-0021

Other identifiers 1

IdentifierTypeStateIssuer
100267288MedicaidCA

Other names 1

  • Redding Rancheria Trinity Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Lori.Hernandez@reddingrancheria-nsn.gov Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040810001377 CA Part B Supplier - Clinic/Group Practice 7810969847 Receives reassigned benefits from 65 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Redding, CA; Weaverville, CA
O20171002000340 CA Part A Provider - Federally Qualified Health Center (FQHC) 7810969847 Practice locations: Weaverville, CA

Federally qualified health center certification: CCN 921010

Legal name
REDDING RANCHERIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 28, 2017
Last certification
Sep 28, 2017
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
81 Arbuckle CT
Weaverville, CA 96093-1007

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Glen Ruel Hayward Individual Corporate DirectorExecutive Director of Health Ser Aug 7, 2017
Operational/Managerial ControlExecutive Director of Health Ser Aug 7, 2017
Redding Rancheria Organization, Redding, CA 5% Or Greater Direct Ownership Interest Aug 7, 2017 100%
Operational/Managerial Control Aug 7, 2017
Tracy L Edwards Individual Corporate OfficerChief Executive Officer Aug 7, 2017 100%
Tamra Dawn Olson Individual Corporate OfficerChief Financial Officer Aug 7, 2017 100%
Paul R Davis Individual Corporate DirectorMedical Director Aug 7, 2017
Stacey Carman Individual Corporate OfficerChief Operating Officer Aug 7, 2017 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Redding RancheriaRedding, CA, CCN 051901 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 21, 1998
Redding Rancheria Center for Advanced CareRedding, CA, CCN A01879 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 7, 2017

National Provider Directory

National Provider Directory
Tax ID family
Redding Rancheria4 organizations share this tax ID, including this one
Part of
Redding Rancheria

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • Direct secure messaging: lori.hernandez@reddingrancheria-nsn.gov

Owners & managing parties with NPI records 4

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 3

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

Other NPIs with the same Medicare PAC ID 2

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

Facilities with the same owner 2

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

Practitioners 47

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

View all 47

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
05D0713527Redding Rancheria Trinity81 Arbuckle Court, Weaverville, CA 96093Provider-performed microscopyAug 31, 2026

NPI Registry JSON

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

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654041600000",
    "number": "1386164580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 LIBERTY ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010811",
            "telephone_number": "530-224-2700",
            "fax_number": "530-224-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "81 ARBUCKLE COURT",
            "city": "WEAVERVILLE",
            "state": "CA",
            "postal_code": "96093",
            "telephone_number": "530-623-0021",
            "fax_number": "530-623-0025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31660 Hwy 3",
            "address_purpose": "LOCATION",
            "city": "Weaverville",
            "state": "CA",
            "postal_code": "96093",
            "country_code": "US",
            "telephone_number": "530-623-0021",
            "fax_number": "530-623-0025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REDDING RANCHERIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REDDING RANCHERIA",
        "enumeration_date": "2017-06-20",
        "last_updated": "2022-06-01",
        "certification_date": "2022-06-01",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "530-226-1740",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100267288",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Lori.Hernandez@reddingrancheria-nsn.gov",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "81 Arbuckle Court",
            "city": "Weaverville",
            "state": "CA",
            "country_code": "US",
            "postal_code": "96093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Redding Rancheria Trinity Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Redding Rancheria Trinity Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Weaverville, CA

Sources for this page

Verify at the official NPI Registry.