NPIMap

Organization Active NPI

Ukiah Adventist Hospital

  • Rural Health Clinic/Center
  • Fort Bragg, CA
National Provider Identifier
1588095848
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
UKIAH ADVENTIST HOSPITAL
Practice address
850 Sequoia Cir
Fort Bragg, CA 95437-5490
Phone
(707) 964-0259
Fax
(707) 964-0765
NPI assigned
Dec 11, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Mr. Parker Pridgen
Title
President
Phone
(707) 456-3010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

850 Sequoia Cir
Fort Bragg, CA 95437-5490

Mailing address

PO Box 888867
Los Angeles, CA 90088-8867

Other names 1

  • Adventist Health Ukiah Valley Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140820001101 CA Part A Provider - Rural Health Clinic 6406816123 Practice locations: Fort Bragg, CA

Rural health clinic certification: CCN 058684

Legal name
UKIAH ADVENTIST HOSPITAL
Doing business as
ADVENTIST HEALTH UKIAH VALLEY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 18, 2003
Last certification
Sep 7, 2017
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 25, 1967 in CA
Enrollment address
850 Sequoia Cir
Fort Bragg, CA 95437-5490
Related CCNs
050301

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).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0612017Adventist Health Ukiah Valley (Ahuv)850 Sequoia Circle, Fort Bragg, CA 95437Certificate of waiverJul 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Ukiah Adventist Hosp PH5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Kerry L Heinrich Individual Corporate OfficerChair Jan 1, 2022
Corporate DirectorBoard Member Dec 16, 2014
John H Cress Individual Corporate DirectorBoard Member Oct 1, 2024
Meredith S Jobe Individual Corporate OfficerSecretary Mar 31, 2014
Eric a Stevens Individual Corporate OfficerPresident Jul 8, 2024
W-2 Managing Employee Jul 8, 2024
Richard K Reiner Individual Corporate DirectorBoard Member Jan 16, 2017
Joy a. Fehr Individual Corporate DirectorBoard Member Oct 1, 2020
Jonathan J Daggett Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew R Davis Individual Corporate DirectorBoard Member May 5, 2017
Todd N Hofheins Individual Corporate OfficerVice Chair Jan 24, 2022
Ann K Beckett Individual Corporate DirectorBoard Member Jan 1, 2024
Marc K Woodson Individual Corporate DirectorBoard Member Jan 1, 2019
John C Freedman Individual Corporate DirectorBoard Member Sep 26, 2016
Jeffrey R Mock Individual Corporate OfficerTreasurer Sep 18, 2023
Jack W Wagner Individual Corporate DirectorBoard Member Dec 1, 2022
Kenneth Jutzy Individual Corporate DirectorBoard Member Jan 1, 2024
Bradford C Newton Individual Corporate DirectorBoard Member Aug 16, 2021
Robert a Cherry Individual Corporate DirectorBoard Member May 5, 2017
Larry L Innocent Individual Corporate DirectorBoard Member Sep 19, 2011
Adventist Health System/West Organization, Roseville, CA Corporation, Non-profit Operational/Managerial Control Jun 16, 1980 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 105

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

View all 105

NPI Registry JSON

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

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1588095848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 888867",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900888867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 SEQUOIA CIR",
            "city": "FORT BRAGG",
            "state": "CA",
            "postal_code": "954375490",
            "telephone_number": "707-964-0259",
            "fax_number": "707-964-0765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UKIAH ADVENTIST HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-11",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "PRIDGEN",
        "authorized_official_first_name": "PARKER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-456-3010",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "850 Sequoia Cir",
            "city": "Fort Bragg",
            "state": "CA",
            "country_code": "US",
            "postal_code": "954375490",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Adventist Health Ukiah Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Bragg, CA

Sources for this page

Verify at the official NPI Registry.