NPIMap

Organization Active NPI

Palm Drive Health Care District

  • General Acute Care Hospital
  • Sebastopol, CA
National Provider Identifier
1508891649
Registry record updated Mar 17, 2016
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Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
110000091 Issued in CA
Legal business name
PALM DRIVE HEALTH CARE DISTRICT
Practice address
501 Petaluma Ave
Sebastopol, CA 95472-4215
Phone
(707) 823-8511
Fax
(707) 829-4141
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Authorized official

Name
Alanna Brogan, MS,RN
Title
Executive Director
Phone
(707) 823-3682

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 110000091 CA Primary

Addresses

Primary practice location

501 Petaluma Ave
Sebastopol, CA 95472-4215

Mailing address

612 Petaluma Ave
Sebastopol, CA 95472
Phone (707) 823-3682

Other identifiers 2

IdentifierTypeStateIssuer
9647041MedicaidCA
ZZR00385IMedicaidCA

Other names 1

  • Sonoma West Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Hospital certification: CCN 050385

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SONOMA WEST MEDICAL CENTER
Certification status
Terminated Voluntary: merger or closure, Apr 28, 2014
Provider type (POS)
Hospital – Short-term
Participating since
Jun 4, 1976
Last certification
Jan 14, 2005
Beds
37
Ownership / control type
Other
Most recent change of ownership
Mar 1, 1999 (2 total)
Facility address
501 Petaluma Ave
Sebastopol, CA 95472

National Provider Directory

National Provider Directory

Locations

612 Petaluma Ave
Sebastopol, CA 95472
Phone (707) 823-3586

6800 Palm Ave
Ste D
Sebastopol, CA 95472
Phone (707) 823-7616

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1508891649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 PETALUMA AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "95472",
            "telephone_number": "707-823-3682",
            "fax_number": "707-829-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 PETALUMA AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724215",
            "telephone_number": "707-823-8511",
            "fax_number": "707-829-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM DRIVE HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "BROGAN",
        "authorized_official_first_name": "ALANNA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-823-3682",
        "authorized_official_credential": "MS,RN"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "110000091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9647041",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR00385I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sonoma West Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sebastopol, CA

Sources for this page

Verify at the official NPI Registry.