NPIMap

Organization Active NPI

United Indian Health Services, Inc.

  • Primary Care Clinic/Center
  • Arcata, CA
National Provider Identifier
1497751572
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
UNITED INDIAN HEALTH SERVICES, INC.
Practice address
1600 Weeot Way
Arcata, CA 95521-4734
Phone
(707) 825-5000
Fax
(707) 825-6747
NPI assigned
Jun 23, 2005
Last updated
Aug 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Authorized official

Name
Cecil Paul Wilson
Title
Cfo
Phone
(707) 825-4065

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X
Nutritionist 133N00000X
Optometrist 152W00000X
Community Health Clinic/Center 261QC1500X 11000347 CA
Dental Clinic/Center 261QD0000X
Primary Care Clinic/Center 261QP2300X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

1600 Weeot Way
Arcata, CA 95521-4734

Mailing address

1600 Weeot Way
Arcata, CA 95521-4734
Phone (707) 825-5000

Other names 1

  • Potawot Health Village Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040225000459 CA Part B Supplier - Clinic/Group Practice 9830085075 Receives reassigned benefits from 66 practitioners
8 other NPIs on this enrollment
Practice locations: Eureka, CA; Smith River, CA; Klamath, CA; Hoopa, CA; Crescent City, CA; Arcata, CA
O20090408000460 CA Part A Provider - Federally Qualified Health Center (FQHC) 9830085075 Practice locations: Arcata, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497751572. Details of each certification follow.

Federally qualified health center certification: CCN 051163

Legal name
UNITED INDIAN HEALTH SERVICES, INC.
Doing business as
POTAWOT HEALTH VILLAGE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 1, 2009
Last certification
May 1, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1970 in CA
Enrollment address
1600 Weeot Way
Arcata, CA 95521-4734

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Locations

4779 Valley East Blvd
Arcata, CA 95521
Phone (707) 825-5000

1675 Northcrest Dr
Crescent City, CA 95531
Phone (707) 464-2750

2332 Harrison Ave
Ste C
Eureka, CA 95501
Phone (707) 442-0380

2332 Harrison Ave
Ste D
Eureka, CA 95501
Phone (707) 445-8080

2332 Harrison Ave
Ste Dc
Eureka, CA 95501

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Elizabeth Lara-O'Rourke Individual Corporate OfficerChief Executive Officer Nov 1, 2021
Operational/Managerial ControlChief Executive Officer Nov 1, 2021
Cecil Wilson Individual Corporate OfficerChief Financial Officer Nov 15, 2021
Operational/Managerial ControlChief Financial Officer Nov 15, 2021
Christopher Myers Individual Corporate OfficerChief Clinical Officer Sep 20, 2021
Operational/Managerial ControlChief Clinical Officer Sep 20, 2021
United Indian Health Services, Inc. Organization, Arcata, CA Corporation, Non-profit Operational/Managerial Control Jul 1, 2009

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 7

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

FacilityTypeRoleSince
United Indian Health Services, Inc.Eureka, CA, CCN 051167 Federally qualified health center Operational/Managerial Control Jun 30, 2009
United Indian Health Services, Inc.Weitchpec, CA, CCN 051165 Federally qualified health center Operational/Managerial Control Jun 4, 2009
United Indian Health Services, Inc.Crescent City, CA, CCN 051166 Federally qualified health center Operational/Managerial Control (100%) Dec 15, 2014
United Indian Health Services, Inc.Klamath, CA, CCN 051164 Federally qualified health center Operational/Managerial Control Jul 1, 2009
Xaa-Wan'-K'WVT ClinicSmith River, CA, CCN 751951 Federally qualified health center Operational/Managerial Control Mar 1, 2017
United Indian Health Services, Inc.Eureka, CA, CCN A01807 Federally qualified health center Operational/Managerial Control Oct 1, 2022
United Indian Health Services, Inc.Eureka, CA, CCN A01820 Federally qualified health center Other (100%) Aug 1, 2023

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 88

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.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1497751572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WEEOT WAY",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955214734",
            "telephone_number": "707-825-5000",
            "fax_number": "707-825-6747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WEEOT WAY",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955214734",
            "telephone_number": "707-825-5000",
            "fax_number": "707-825-6747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED INDIAN HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "CECIL",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "707-825-4065"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "11000347",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Potawot Health Village",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Arcata, CA

Sources for this page

Verify at the official NPI Registry.