Tipton Medical Clinic
Organization Active NPI Rural Health Clinic/Center · Tipton, CA
NPI 1528072527 · NPPES record last updated Apr 12, 2024
Key facts
- NPI
- 1528072527
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- RHM53969F (CA)
- Legal business name
- TIPTON MEDICAL CLINIC
- Practice address
- 565 N Thompson Rd
Tipton, CA 93272-9756 - Phone
- (559) 752-4147
- Fax
- (559) 752-4150
- NPI assigned
- Jul 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Linda Roberts, RN
- Title
- Ceo
- Phone
- (559) 757-4147
Owners & managing parties with NPI records 1
Facilities with the same owner 1
Practitioners 12
-
Daisy Rodriguez, FNP-C
-
Lupita Noemi Alvarez, P.A
-
Kristin Rene Brown, NURSE PRACTITIONER
-
Marissa Perez Hernandez, FNP-BC
-
Brian Scott Penton, M.D.
-
Tomas B Rios, M.D.
-
Shawn Thomas Seita, NP-C
-
Evelyn Wilkerson, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1010932 | Tipton Medical Clinic | Certificate of waiver | Mar 26, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Rural health clinic certification: CCN 553969
- Legal name
- TIPTON MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Sep 30, 2003
- Last certification
- Aug 29, 2017
- Ownership / control type
- 1C
- Organization structure
- Partnership · Proprietary
- Enrollment address
- 565 N Thompson Rd
Tipton, CA 93272-9756
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Berkley Roberts |
Contracted Managing Employee |
Jan 1, 2025 | 100% |
| Linda Roberts |
General Partnership Interest |
Mar 1, 2001 | 49% |
| Corporate Director |
Jun 23, 2003 | ||
| Rios/Roberts, LLC |
5% Or Greater Direct Ownership Interest | Jun 15, 2008 | 100% |
| Operational/Managerial Control | Mar 1, 2001 | ||
| Saman Ratnayake |
General Partnership Interest |
Jun 23, 2003 | 51% |
| Corporate Director |
Jun 23, 2003 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030515000044 | CA | Part a Provider - Rural Health Clinic | 5395655856 | Practice locations: Tipton, CA |
National Provider Directory
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | RHM53969F | CA | Yes |
Addresses
Primary practice location
565 N Thompson Rd
Tipton, CA 93272-9756
Mailing address
PO Box 130
Tipton, CA 93272-0130
Phone (559) 752-4147
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528072527 | Medicaid | CA | |
| 1BZZZ06823Z | Other | CA | BLUE SHIELD |
| RHM53969F | Medicaid | CA | |
| HAP53969F | Medicaid | CA |
Other providers in Tipton, CA
- Careplus Healthcare Inc
- Jennifer Louise Hennick
- Ivan Martinez
- Tipton Elementary School District
- Evelyn Wilkerson
All providers in Tipton, 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 Apr 12, 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.
- 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.