Nathan Dario Brinckhaus
Individual provider Active NPI Family Medicine Physician · Fortuna, CA
NPI 1508156910 · NPPES record last updated Dec 19, 2024
Key facts
- NPI
- 1508156910
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- A124994 (CA)
- Practice address
- 2404 Newburg Rd
Fortuna, CA 95540-2818 - Phone
- (707) 617-2002
- Fax
- (833) 941-4882
- NPI assigned
- Apr 19, 2011
- Reactivated
- Dec 17, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 7
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Loma Linda University School of Medicine, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fortuna Family Medicine Inc
Providence Medical Foundation
Practice addresses (Care Compare)
2404 Newburg Rd
Fortuna, CA 95540-2818
3300 Renner Dr
Fortuna, CA 95540-3120
Phone (707) 725-3361
Hospital & facility affiliations
- Providence at Home With Compassus Home Health, Humboldt
- Providence St Joseph Hospital
- Providence Redwood Memorial Hospital
- Mad River Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Fortuna Family Medicine Inc |
Rural health clinic | W-2 Managing Employee (100%) | Sep 13, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250416002044 | CA | Practitioner - Family Practice |
1355560541 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Medical Foundation | Current | Accepting new patients | |
| Providence Medical Foundation | Current |
Accepting new patients | |
| Providence Medical Foundation | Family Medicine | Past | Accepting new patients |
Locations
2700 Dolbeer St
Eureka, CA 95501
Phone (707) 269-4229
3300 Renner Dr
Fortuna, CA 95540
Phone (707) 725-3361
1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210
500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842
Interoperability endpoints
- nathan.brinckhaus.1@28668.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A124994 | CA | Yes |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
2404 Newburg Rd
Fortuna, CA 95540-2818
Mailing address
2404 Newburg Rd
Fortuna, CA 95540-2818
Phone (707) 617-2002
Other providers in Fortuna, CA
- Elaine K Bettiga
- Andrew Allen Billings
- Brandon Eugene Bireley
- Diederik-Jan Frederick Bouwmeester
- Ashley Megan Bramlett
- Ruben E Brinckhaus
- Broadway Medical Service & Supply, Inc
- Jennifer Brown
- Kelly Usborne Bruce
- Andrey Buie
All providers in Fortuna, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2024. 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.
- Order and Referring (CMS).
- 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.