Mark Twain Medical Center
Organization Active NPI Critical Access Hospital · San Andreas, CA
NPI 1508968819 · NPPES record last updated Apr 15, 2021
Key facts
- NPI
- 1508968819
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- MARK TWAIN MEDICAL CENTER
- Practice address
- 768 Mountain Ranch Rd
San Andreas, CA 95249-9707 - Phone
- (209) 754-3521
- Fax
- (209) 754-2675
- NPI assigned
- Sep 5, 2006
- Organization subpart
- No
Authorized official
- Name
- John Chivers
- Title
- Chief Financial Officer
- Phone
- (209) 754-2614
Owners & managing parties with NPI records 16
-
Pardeep Athwal, M.D.
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 4
Member of 2
Related certifications (CCN) 3
Facilities with the same owner 71
Practitioners 116
-
Edward L Cahill, MD
-
Shelby Conklin, PA-C
-
Shikha Jain, D.C.
-
Laura Camille Jones, MD, MS
-
Karen Karam, LCSW
-
Dean Matthew Kelaita, M.D.
-
John Brennan Krpan, D.O.
-
Michael Thomas Laird, M.D.
-
Lindell Krpan Maloney, PA-C
-
Cecilia I McPherson, L.C.S.W.
-
Renee L. Perry, DO
-
Estefania S. Way, M.D.
-
George 'Dean' White, L.C.S.W.
-
Hayes Robert Wilson, PA-C
Affiliated clinicians 204
-
Roozbeh A. Ahmadi, M.D.
-
Siraj K Ahmed, M.D.
-
Tareq Ali, M.D.
-
Haytham Aljoudi, MD
-
Ezell Askew Jr., MD
-
Pardeep Athwal, M.D.
-
Shagun Bagga-Malhotra, M.D.
-
Neelesh S Bangalore, MD, PHD
-
Manreet Basra, M.D.
-
Dildeep Batth, M.D.
-
Kelsey Belcourt, FNP
-
Kevin Charles Booth, M.D.
-
Angelica Buenrostro, PA-C
-
Cyrus Buhari, DO
-
Fram Buhari, MD
-
Shiraz Buhari, MD
-
Martin Cadeiras, MD
-
Edward L Cahill, MD
-
Elgie A Camales, N.P.
-
Rebecca Carrillo, M.D.
Medicare Care Compare: Hospital
- Listed as
- Mark Twain Medical Center
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Other
- Medicare certification status
- Active
- Emergency services
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in CA
Hospital certification: CCN 051332
- Legal name
- MARK TWAIN MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Aug 6, 2010
- Last certification
- Apr 3, 2016
- Beds
- 25
- Ownership / control type
- Other
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 18, 1987 in CA
- Enrollment address
- 768 Mountain Ranch Rd
San Andreas, CA 95249-9707
Hospital certification: CCN 05Z332
- Legal name
- MARK TWAIN MEDICAL CENTER
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 18, 1987 in CA
- Enrollment address
- 768 Mountain Ranch Rd
San Andreas, CA 95249-9707
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Commonspirit Health |
Other | May 31, 2019 | |
| 5% Or Greater Indirect Ownership Interest | Feb 1, 2019 | 99% | |
| Other | Feb 1, 2019 | 99% | |
| Charles J Kassis |
Corporate Director |
Aug 30, 2018 | |
| Christopher M Champlin |
Corporate Director |
May 31, 2019 | |
| Linda Reed |
Corporate Director |
Jan 27, 2015 | |
| Dignity Health |
Other | Jun 1, 2000 | |
| Operational/Managerial Control | Feb 1, 2019 | ||
| Other | Feb 1, 2019 | ||
| Lloyd H Dean |
Operational/Managerial Control |
Jun 10, 2016 | |
| Douglas P Archer |
Corporate Officer |
Mar 18, 2019 | 50% |
| Corporate Officer |
Mar 18, 2019 | ||
| W-2 Managing Employee |
Mar 18, 2019 | ||
| Andrea N. Ochoa |
Corporate Officer |
Jan 1, 2021 | |
| Corporate Officer |
May 1, 2021 | ||
| Steven W Scharmann |
Corporate Officer |
Feb 1, 2019 | |
| John E Petersdorf |
Corporate Officer |
Feb 1, 2019 | |
| Dignity Community Care |
Other | May 31, 2019 | 99% |
| 5% Or Greater Indirect Ownership Interest | Feb 1, 2019 | 99% | |
| Randall Ross |
Corporate Director |
Jul 2, 2017 | |
| Pardeep Athwal |
Corporate Officer |
Sep 25, 2020 | |
| Daniel Morissette |
Corporate Officer |
Feb 1, 2019 | |
| Other |
Sep 1, 2023 | ||
| Tamra Kelly |
Corporate Director |
Mar 1, 2022 | |
| Kathy Kohrman |
Corporate Director |
Dec 2, 2021 | |
| Mark Twain Health Care District |
5% Or Greater Direct Ownership Interest | Feb 1, 2019 | 1% |
| Daryn J Kumar |
Corporate Director |
Jan 28, 2022 | |
| Mark Twain Medical Center |
5% Or Greater Direct Ownership Interest | Mar 18, 1987 | 99% |
| Operational/Managerial Control | Mar 18, 1987 | 99% | |
| Theresa M Hylen |
Corporate Director |
Sep 1, 2021 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Family Medical Center - Arnold |
Rural health clinic | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Mar 18, 1987 Mar 18, 1987 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061006000227 | CA | Part B Supplier - Clinic/Group Practice | 8820073711 |
Receives reassigned benefits from 51 practitioners 1 other NPI on this enrollment Practice locations: Angels Camp, CA; Arnold, CA; San Andreas, CA |
| O20090626000537 | CA | Part a Provider - Critical Access Hospital | 8820073711 | Practice locations: San Andreas, CA |
| O20181012000946 | CA | Part a Provider - Critical Access Hospital | 8820073711 | Practice locations: San Andreas, CA |
National Provider Directory
Locations
585 Stanislaus Ave
Ste A
Angels Camp, CA 95222
Phone (209) 736-2030
585 Stanislaus Ave
Angels Camp, CA 95222
2182 Hwy 4
Ste A
Arnold, CA 95223
815 Bay Ave
Ste B
Capitola, CA 95010
Phone (831) 423-4111
3505 Spangler Ln
#44
Copperopolis, CA 95228
Phone (209) 785-7000
3505 Spangler Ln
Copperopolis, CA 95228
Phone (209) 785-7000
430 Sawmill Creek Rd
Copperopolis, CA 95228
Phone (209) 785-0000
3505 Spangler Ln
Ste 44
Copperopolis, CA 95228
Phone (209) 785-7000
704 Mountain Ranch Rd
Ste 103104
San Andreas, CA 95249
Phone (209) 754-3521
700 Mountain Ranch Rd
Ste B1
San Andreas, CA 95249
Phone (209) 754-4967
700 Mountain Ranch Rd
Ste B
San Andreas, CA 95249
Phone (209) 754-9670
1919 Vista del Lago Dr
Ste 9
Valley Springs, CA 95252
Phone (209) 772-9538
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 030000058 | CA | |
| Critical Access Hospital | 282NC0060X | Yes |
Addresses
Primary practice location
768 Mountain Ranch Rd
San Andreas, CA 95249-9707
Mailing address
768 Mountain Ranch Rd
San Andreas, CA 95249-9707
Phone (209) 754-3521
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZR00366G | Medicaid | CA | |
| LTC30366G | Medicaid | CA | |
| ZZZC0502Z | Other | BLUE SHIELD OF CA | |
| 233520100 | Other | DEPT. OF LABOR - WC | |
| HSP40366G | Medicaid | CA |
Other providers in San Andreas, CA
- M a C T Health Board, Incorporated
- Heather Nicole Mack
- Pilar Majors
- Mark Twain Medical Center
- Mark Twain Medical Center
- Carley Martin
- Rocky Ben Martinez Jr.
- Kabir Singh Matharu
- Francis Mark McCormick
- Andrew C McCoy
All providers in San Andreas, CA · Critical Access Hospital in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2021. 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.
- 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.