NPIMap

Organization Active NPI

Hazel Hawkins Memorial Hospital

Doing business as Barragan Family Health Care and Diabetic Care Center

  • Rural Health Clinic/Center
  • Hollister, CA
National Provider Identifier
1487196408
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
070000004 Issued in CA
Legal business name
HAZEL HAWKINS MEMORIAL HOSPITAL
Doing business as
Barragan Family Health Care and Diabetic Care Center
Practice address
911 Sunset Dr
Hollister, CA 95023-5606
Phone
(831) 636-2626
Fax
(831) 637-3126
NPI assigned
Nov 8, 2016
Last updated
Jan 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Authorized official

Name
Mrs. Mary Casillas
Title
Ceo
Phone
(831) 636-2604

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 070000004 CA Primary

Addresses

Primary practice location

911 Sunset Dr
Hollister, CA 95023-5606

Mailing address

930 Sunnyslope Rd Ste A2
Hollister, CA 95023-5616

Other names 1

  • Barragan Family Health Care and Diabetic Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170619001745 CA Part A Provider - Rural Health Clinic 9133038326 Practice locations: Hollister, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487196408. Details of each certification follow.

Rural health clinic certification: CCN 058705

Legal name
HAZEL HAWKINS MEMORIAL HOSPITAL
Doing business as
BARRAGAN FAMILY HEALTH CARE AND DIABETES CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Nov 8, 2018
Last certification
Nov 8, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Enrollment address
930 Sunnyslope Rd
Ste A2
Hollister, CA 95023-5616
Related CCNs
050296

Other NPIs with the same Medicare PAC ID 7

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

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
05D2133706Barragan Family Health Care & Diabetes Center930 Sunnyslope Rd Ste a-2, Hollister, CA 95023Certificate of waiverJul 17, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hazel Hawkins HSP Rad D10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

930 Sunnyslope Rd
Ste A2
Hollister, CA 95023
Phone (408) 847-6191

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Jerrianne M Hernandez Individual Corporate DirectorBoard Member Nov 1, 2016
Ariel M Hurtado Individual Corporate DirectorBoard Member Nov 16, 2016
Josefa Sanchez Individual Corporate DirectorBoard Member Nov 14, 2014
Mary McCullough Individual Corporate DirectorBoard Member Dec 3, 1982
Kenneth S Underwood Individual Corporate OfficerCeo Aug 1, 2008
W-2 Managing EmployeeCeo Aug 1, 2008
Angelina de Lacruz Individual Corporate DirectorBoard Member Nov 16, 2016
Hazel Hawkins Memorial Hospital Organization, Hollister, CA Non-profit Operational/Managerial Control Dec 15, 2005 100%

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Mabie First Street Healthcare CenterHollister, CA, CCN 058660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2012

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

NPI Registry JSON

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

{
    "created_epoch": "1478563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1487196408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 SUNNYSLOPE RD STE A2",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 SUNSET DR",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235606",
            "telephone_number": "831-636-2626",
            "fax_number": "831-637-3126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL HAWKINS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-08",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "CASILLAS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "831-636-2604",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "070000004",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Barragan Family Health Care and Diabetic Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Barragan Family Health Care and Diabetic Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollister, CA

Sources for this page

Verify at the official NPI Registry.