NPIMap

Organization Active NPI

Mendocino Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ukiah, CA
National Provider Identifier
1497961106
Registry record updated Mar 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
110000236 Issued in CA
Legal business name
MENDOCINO COMMUNITY HEALTH CLINIC, INC.
Practice address
333 Laws Ave
Ukiah, CA 95482-6540
Phone
(707) 468-1010
Fax
(707) 462-7078
NPI assigned
May 16, 2007
Last updated
Mar 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2013

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

Authorized official

Name
Mrs. Linnea J Hunter
Title
C.E.O.
Phone
(707) 472-4511

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 110000360 CA
Federally Qualified Health Center (FQHC) 261QF0400X 110000500 CA
Federally Qualified Health Center (FQHC) 261QF0400X 110000236 CA Primary

Addresses

Primary practice location

333 Laws Ave
Ukiah, CA 95482-6540

Mailing address

333 Laws Ave
Ukiah, CA 95482-6540
Phone (707) 468-1010

Other identifiers 3

IdentifierTypeStateIssuer
FHC70845FMedicaidCA
FHC70968FMedicaidCA
FHC03933FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040826001483 CA Part B Supplier - Clinic/Group Practice 6305755455 Receives reassigned benefits from 135 practitioners
3 other NPIs on this enrollment
Practice locations: Lakeport, CA; Ukiah, CA; Willits, CA

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

5335 Lakeshore Blvd
Lakeport, CA 95453
Phone (707) 263-7725

Practitioners & affiliated clinicians

Practitioners 138

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 138

NPI Registry JSON

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363046400000",
    "number": "1497961106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 LAWS AVE",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954826540",
            "telephone_number": "707-468-1010",
            "fax_number": "707-462-7078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 LAWS AVE",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954826540",
            "telephone_number": "707-468-1010",
            "fax_number": "707-462-7078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOCINO COMMUNITY HEALTH CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2013-03-12",
        "status": "A",
        "authorized_official_last_name": "HUNTER",
        "authorized_official_first_name": "LINNEA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "707-472-4511",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "110000360",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "110000500",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "110000236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70845F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70968F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03933F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.