NPIMap

Organization Active NPI

Mark Twain Medical Center

  • Critical Access Hospital
  • San Andreas, CA
National Provider Identifier
1508968819
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 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
Last updated
Apr 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Authorized official

Name
John Chivers
Title
Chief Financial Officer
Phone
(209) 754-2614

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 030000058 CA
Critical Access Hospital 282NC0060X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1508968819. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Mar 18, 1987 in CA
Enrollment address
768 Mountain Ranch Rd
San Andreas, CA 95249-9707
Other Hospital Practice Location

Hospital certification: CCN 05Z332

Legal name
MARK TWAIN MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Mar 18, 1987 in CA
Enrollment address
768 Mountain Ranch Rd
San Andreas, CA 95249-9707
Main/Primary Hospital Location

Hospital certification: CCN 050366

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
MARK TWAIN ST JOSEPH'S HOSPITAL
Certification status
Terminated Other: provider status change, Aug 5, 2010
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 28, 1993
Beds
48
Ownership / control type
Other
Facility address
768 Mountain Ranch Rd
San Andreas, CA 95249

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mark Twain Medical CenterCCN 051332 · All quality measures
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

585 Stanislaus Ave
Angels Camp, CA 95222

585 Stanislaus Ave
Ste A
Angels Camp, CA 95222
Phone (209) 736-2030

2182 Hwy 4
Ste A
Arnold, CA 95223

815 Bay Ave
Ste B
Capitola, CA 95010
Phone (831) 460-7300

3505 Spangler Ln
Copperopolis, CA 95228
Phone (209) 785-7000

3505 Spangler Ln
#44
Copperopolis, CA 95228
Phone (209) 785-7000

3505 Spangler Ln
Ste 44
Copperopolis, CA 95228
Phone (209) 785-7000

800 E Washington Blvd
Crescent City, CA 95531
Phone (707) 464-8511

700 Mountain Ranch Rd
Ste 102
San Andreas, CA 95249

700 Mountain Ranch Rd
Ste B1
San Andreas, CA 95249
Phone (209) 754-4967

704 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 754-3521

704 Mountain Ranch Rd
Ste 103104
San Andreas, CA 95249
Phone (209) 754-3521

1919 Vista del Lago Dr
Ste 9
Valley Springs, CA 95252
Phone (209) 772-9538

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Commonspirit Health Organization, Chicago, IL Corporation, Non-profit Other May 31, 2019
5% Or Greater Indirect Ownership Interest Feb 1, 2019 99%
Other Feb 1, 2019 99%
Charles J Kassis Individual Corporate DirectorBoard Member Aug 30, 2018
Christopher M Champlin Individual Corporate DirectorBoard Member May 31, 2019
Linda Reed Individual Corporate DirectorBoard Member Jan 27, 2015
Dignity Health Organization, San Francisco, CA Corporation, Non-profit Other Jun 1, 2000
Operational/Managerial Control Feb 1, 2019
Other Feb 1, 2019
Lloyd H Dean Individual Operational/Managerial ControlPresident and Ceo of Dignity Hea Jun 10, 2016
Douglas P Archer Individual Corporate OfficerPresident and Ceo Mar 18, 2019 50%
Corporate OfficerPresident and Ceo Mar 18, 2019
W-2 Managing EmployeePresident and Ceo Mar 18, 2019
Andrea N. Ochoa Individual Corporate OfficerCfo/ VP of Finance Jan 1, 2021
Corporate OfficerChief Financial Officer May 1, 2021
Steven W Scharmann Individual Corporate OfficerVP, Finance & Rev Cycle Feb 1, 2019
John E Petersdorf Individual Corporate OfficerSVP / Operations Finance Feb 1, 2019
Dignity Community Care Organization, San Francisco, CA Corporation, Non-profit Other May 31, 2019 99%
5% Or Greater Indirect Ownership Interest Feb 1, 2019 99%
Randall Ross Individual Corporate DirectorBoard Member Jul 2, 2017
Pardeep Athwal Individual Corporate OfficerChief Medical Officer Sep 25, 2020
Daniel Morissette Individual Corporate OfficerChief Financial Officer Feb 1, 2019
OtherChief Financial Officer Sep 1, 2023
Tamra Kelly Individual Corporate DirectorDirector Mar 1, 2022
Kathy Kohrman Individual Corporate DirectorDirector Dec 2, 2021
Mark Twain Health Care District Organization, San Andreas, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2019 1%
Daryn J Kumar Individual Corporate DirectorChairman, Director Jan 28, 2022
Mark Twain Medical Center Organization, San Andreas, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 18, 1987 99%
Operational/Managerial Control Mar 18, 1987 99%
Theresa M Hylen Individual Corporate DirectorDirector, Secretary Sep 1, 2021

Owners & managing parties with NPI records 16

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 16

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Family Medical Center - ArnoldArnold, CA, CCN 058573 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Mar 18, 1987
Mar 18, 1987

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Mark Twain Medical Center

    dba Family Medical Center - Arnold

    • Rural Health Clinic/Center
    • Arnold, CA
    • NPI 1790846301

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 71

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 71

Practitioners & affiliated clinicians

Practitioners 114

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 114

Affiliated clinicians 204

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 204

NPI Registry JSON

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1508968819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "768 MOUNTAIN RANCH RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499707",
            "telephone_number": "209-754-3521",
            "fax_number": "209-754-2675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "768 MOUNTAIN RANCH RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499707",
            "telephone_number": "209-754-3521",
            "fax_number": "209-754-2675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK TWAIN MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "CHIVERS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "209-754-2614"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "030000058",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Andreas, CA

Sources for this page

Verify at the official NPI Registry.