Frontier Village Family Health Center, Inc

Key facts

NPI: 1477667384
Entity type: Organization (NPI type 2)
Primary specialty: Rural Health Clinic/Center 261QR1300X
Legal business name: FRONTIER VILLAGE FAMILY HEALTH CENTER, INC
Practice address: 645 Antelope Blvd Ste 24
Red Bluff, CA 96080-2463
Phone: (530) 528-7650
Fax: (530) 528-7655
NPI assigned: Aug 18, 2006
Organization subpart: No

Authorized official

Name: Dr. Jagraj S Nijjar, MD
Title: President/Ceo
Phone: (530) 528-7650

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Colusa Medical Center, LLC Rural Health Clinic/Center · Red Bluff, CA · NPI 1972072163

CMS change of ownership Sold to · 2019-01-01

Practitioners 2

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

Jessie E Corpus, P.A. Medical Physician Assistant · Orland, CA · NPI 1245272046

NPD
James Richard Pearson Jr., PAC Medical Physician Assistant · Corning, CA · NPI 1598756942

NPD

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
05D0952805	Frontier Village Family 645 Antelope Blvd, Ste 24, Red Bluff, CA 96080	Certificate of waiver	Jul 20, 2027

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

Change-of-ownership history

Date	Event	Counterparty
Jan 1, 2019	Change of Ownership This provider was the seller	Colusa Medical Center, LLC CCN 058722 · CA · NPI 1972072163

National Provider Directory

Networks

BSC 65 PLUS INDIVIDUAL MAPD
Plans: 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)…

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Rural Health Clinic/Center	261QR1300X			Yes

Addresses

Primary practice location

645 Antelope Blvd Ste 24
Red Bluff, CA 96080-2463

Mailing address

645 Antelope Blvd Ste 24
Red Bluff, CA 96080-2463
Phone (530) 528-7650

Other identifiers

Identifier	Type	State	Issuer
RHM53909G	Medicaid	CA

Other providers in Red Bluff, CA

All providers in Red Bluff, 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 Aug 8, 2014. 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.

Verify at the official NPI Registry.