Sutter Bay Hospitals
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Lakeport, CA
NPI 1598098642 · NPPES record last updated Jan 20, 2022
Key facts
- NPI
- 1598098642
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 110000094 (CA)
- Legal business name
- SUTTER BAY HOSPITALS
- Practice address
- 5176 Hill Rd E
Lakeport, CA 95453-6300 - Phone
- (707) 262-5000
- Fax
- (707) 262-5003
- NPI assigned
- Sep 8, 2009
- Organization subpart
- No
Authorized official
- Name
- John B. Gates
- Title
- Cfo
- Phone
- (510) 450-7357
Owners & managing parties with NPI records 4
-
Aditi Patel, D.O
-
Todd C Smith, M.D.
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 22
Corporate family (same tax ID) 24
Related certifications (CCN) 1
Facilities with the same owner 59
Practitioners 142
-
Daniel Adam Brenner, MD / PHD
-
Elyse Midori Donald, M.D.
-
Matthew McQuaid, DPM
-
Daniel Alekyan, DO
-
Donovan C Bland, MD
-
Kimberly Ann Cirella, CNM, WHNP
-
Nabil Elkhoury, M.D.
-
Jayla Flaum, PA-C
-
Milcah Wanjiku Gichuru, FNP-BC
-
Amita Kachru, M.D.
-
Hemal H. Kadakia, M.D.
-
Eileen R Kalk, PA
-
Michelle Denise Marieni, M.D.
Affiliated clinicians 1
-
Sangye Shrestha, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Hospital certification: CCN 05Z329
- Legal name
- SUTTER BAY HOSPITALS
- Doing business as
- SUTTER LAKESIDE HOSPITAL
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 9, 1885 in CA
- Enrollment address
- 5176 Hill Rd E
Lakeport, CA 95453-6300
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Yvonne Richardson |
Corporate Director |
Aug 4, 2021 | |
| Todd C Smith |
Corporate Director |
Jun 12, 2023 | |
| Gregory Brown |
Corporate Director |
Jan 1, 2025 | |
| Jill M Kacher Cobb |
Corporate Director |
Jan 1, 2019 | |
| Arnold Schaffer |
Corporate Director |
Jan 1, 2024 | |
| Theodore Deikel |
Corporate Director |
Jan 1, 2010 | |
| Janet Garufis |
Corporate Director |
Jan 1, 2024 | |
| Rita Ophelia Kwan-Feinberg |
Corporate Director |
Jan 1, 2025 | |
| Susan McCabe |
Corporate Director |
Jul 14, 2025 | |
| Juli Maxworthy |
Corporate Director |
Aug 4, 2021 | |
| Henry Yu |
Corporate Officer |
Jun 9, 2023 | |
| W-2 Managing Employee | Jun 9, 2023 | ||
| Heidi J Schmidt |
Corporate Director |
Jan 1, 2025 | |
| Thomas Briody |
Corporate Director |
Feb 8, 2023 | |
| William L Brunetti |
Corporate Director |
Feb 8, 2023 | |
| Jeffrey T Strawn |
Corporate Director |
Jan 1, 2025 | |
| Yumi Nakagawa |
Corporate Director |
Jan 1, 2021 | |
| Sutter Health |
5% Or Greater Direct Ownership Interest | Jan 1, 2010 | |
| Aditi H Patel |
Corporate Director |
Jan 1, 2025 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Sutter Lakeside Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2010 |
| California Pacific Medical Center - Davies Campus |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091029000470 | CA | Part a Provider - Critical Access Hospital | 3476506528 | Practice locations: Lakeport, CA |
National Provider Directory
- Tax ID family
- Psychiatrist Clinic of
Locations
5685 Main St
Kelseyville, CA 95451
Phone (707) 279-8733
5196 Hill Rd E
Ste 201
Lakeport, CA 95453
Phone (707) 263-4108
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 110000094 | CA | Yes |
Addresses
Primary practice location
5176 Hill Rd E
Lakeport, CA 95453-6300
Mailing address
PO Box 742412
Los Angeles, CA 90074-2412
Phone (415) 600-7120
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LTC 30476F | Medicaid | CA |
Other names
- Sutter West Bay Hospitals
Other providers in Lakeport, CA
- Melissa Steyskal
- Betty Ann Strach
- Nelson Strasser
- Tiffani Fawn Strickland
- Sutter Bay Hospitals
- Sutter Bay Hospitals
- Sutter Bay Hospitals
- Sutter Lakeside Home Medical Services
- Sutter Lakeside Hospital
- Sutter Lakeside Hospital
All providers in Lakeport, CA · Medicare Defined Swing Bed Hospital Unit in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.