NPIMap

Organization Active NPI

Sutter Valley Hospitals

Doing business as Memorial Hospital Los Banos/Rural Health Clinic

  • Rural Health Clinic/Center
  • Los Banos, CA
National Provider Identifier
1487017471
Registry record updated Jan 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SUTTER VALLEY HOSPITALS
Doing business as
Memorial Hospital Los Banos/Rural Health Clinic
Practice address
1253 W I St
Los Banos, CA 93635-3930
Phone
(209) 710-6333
Fax
(209) 827-0554
NPI assigned
Mar 29, 2016
Last updated
Jan 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2022

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

Authorized official

Name
Paige A. Terra
Title
Cfo
Phone
(916) 887-7050

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1253 W I St
Los Banos, CA 93635-3930

Mailing address

2700 Gateway Oaks Dr
Suite 2200
Sacramento, CA 95833-4337
Phone (916) 887-7040

Other names 1

  • Memorial Hospital Los Banos/Rural Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170209001805 CA Part A Provider - Rural Health Clinic 3375531635 Practice locations: Los Banos, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487017471. Details of each certification follow.

Rural health clinic certification: CCN 553998

Legal name
SUTTER VALLEY HOSPITALS
Doing business as
MEMORIAL HOSPITAL LOS BANOS RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 10, 1994
Last certification
Jul 5, 2016
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 24, 1935 in CA
Enrollment address
1253 W I St
Los Banos, CA 93635-3930
Related CCNs
050557

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 14

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

View all 14

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
05D2266234Memorial Hospital Rural Los Banos Health Clinic1253 W I Street, Los Banos, CA 93635Certificate of waiverAug 7, 2026

National Provider Directory

National Provider Directory
Tax ID family
Sutter Community Hospit27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Peter V Hull Individual Corporate DirectorBoard Member Jan 1, 2012
I-Mei Hsiu Individual Corporate DirectorBoard Member May 21, 2015
Todd C Smith Individual Corporate DirectorBoard Member May 21, 2015
Marie F Seward Individual Corporate DirectorBoard Member May 21, 2015
Sutter Valley Hospitals Organization, Sacramento, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 1, 2017 100%
Daniel Flores Individual Corporate DirectorBoard Member Sep 1, 2018
Helen M Thomson Individual Corporate DirectorBoard Member Feb 1, 2011
David H Adkins Individual Corporate DirectorBoard Member May 21, 2015
Timothy a Byrd Individual Corporate DirectorBoard Member May 21, 2015
Scott N Howell Individual Corporate DirectorBoard Member Jan 1, 2009
Bronwyn Fields Individual Corporate DirectorBoard Member Sep 1, 2018
Maria G Pallavicini Individual Corporate DirectorBoard Member Aug 3, 2017
Narendra M Pathipati Individual Corporate DirectorBoard Member Oct 1, 2011
Kurt J Shuler Individual Corporate DirectorBoard Member Jan 1, 2015
Jerry Tokunaga Individual Corporate DirectorBoard Member Sep 1, 2018
Sutter Health Organization, Sacramento, CA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest May 1, 1996 100%
Timothy Noakes Individual Corporate Officer Sep 5, 2020
W-2 Managing Employee Sep 5, 2020
Viva Ettin Individual Corporate DirectorBoard Member Feb 7, 2014

Owners & managing parties with NPI records 18

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

View all 18

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Sutter Auburn Faith HospitalAuburn, CA, CCN 050498 Hospital 5% Or Greater Direct Ownership Interest (100%) May 31, 1996
Sutter Solano Medical CenterVallejo, CA, CCN 050101 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2009
Sutter Amador HospitalJackson, CA, CCN 050014 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2009
Memorial Medical CenterModesto, CA, CCN 050557 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2017
Sutter Surgical Hospital-North ValleyYuba City, CA, CCN 050766 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 12, 2026

Owned or controlled facilities with NPI records 6

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

Change-of-ownership history 1

DateEventCounterparty
May 1, 2017 Change of OwnershipThis provider was the buyer Memorial Hospital Los Banos Rural Health ClinicCCN 553998, CA, NPI 1528202090

Change of ownership 1

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

NPI Registry JSON

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641513600000",
    "number": "1487017471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 GATEWAY OAKS DR",
            "address_2": "SUITE 2200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958334337",
            "telephone_number": "916-887-7040",
            "fax_number": "916-887-7041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1253 W I ST",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936353930",
            "telephone_number": "209-710-6333",
            "fax_number": "209-827-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER VALLEY HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A",
        "authorized_official_last_name": "TERRA",
        "authorized_official_first_name": "PAIGE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "916-887-7050"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Hospital Los Banos/Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Hospital Los Banos/Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Banos, CA

Sources for this page

Verify at the official NPI Registry.