Fortuna Family Medicine Inc.
Organization Active NPI Rural Health Clinic/Center · Fortuna, CA
NPI 1508580705 · NPPES record last updated May 29, 2026
Key facts
- NPI
- 1508580705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- FORTUNA FAMILY MEDICINE INC.
- Practice address
- 2404 Newburg Rd
Fortuna, CA 95540-2818 - Phone
- (707) 617-2002
- Fax
- (833) 941-4882
- NPI assigned
- Sep 30, 2022
- Organization subpart
- No
Authorized official
- Name
- Nathan Dario Brinckhaus
- Title
- MD
- Phone
- (707) 617-2002
Owners & managing parties with NPI records 1
Practitioners 11
-
Susie PA Cha, LCSW
-
Mary Terese Dodd, FNP
-
Andrew W Fogg, D.C.
-
Jamie Reed, D.C.
-
Randall Lee Bivens, M.D.
-
Calvin Geogre Hartman, PHYSICAL THERAPIST
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Rural health clinic certification: CCN 558910
- Legal name
- FORTUNA FAMILY MEDICINE INC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 12, 2023
- Last certification
- Sep 12, 2023
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Sep 13, 2022 in CA
- Enrollment address
- 2404 Newburg Rd
Fortuna, CA 95540-2818
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Nathan Dario Brinckhaus |
W-2 Managing Employee |
Sep 13, 2022 | 100% |
| Randall L Bivens |
5% Or Greater Direct Ownership Interest |
Mar 6, 2025 | 100% |
| Corporate Officer |
Mar 6, 2025 | 100% | |
| Corporate Director |
Mar 6, 2025 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230307002112 | CA | Part a Provider - Rural Health Clinic | 6901279264 | Practice locations: Fortuna, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
- Amber Ford
- Fortuna Assisted Living LLC
- Fortuna Chiropractic LLC
- Fortuna Elementary School District
- Fortuna Family Medical Group Inc
- Fortuna Pharmacy Inc
- Fortuna Rehabilitation & Wellness Center, LP
- Fortuna Union High School
- Tatsiana Franco
- Maureen B Frank
All providers in Fortuna, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2026. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.