NPIMap

Organization Active NPI

Open Door Community Health Centers

Doing business as McKinleyville Community Health Center

  • Federally Qualified Health Center (FQHC)
  • McKinleyville, CA
National Provider Identifier
1598858169
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
010000340 Issued in CA
Legal business name
OPEN DOOR COMMUNITY HEALTH CENTERS
Doing business as
McKinleyville Community Health Center
Practice address
1644 Central Avenue
Suite F
McKinleyville, CA 95519
Phone
(707) 839-3068
Fax
(707) 839-3827
NPI assigned
Oct 2, 2006
Last updated
Jun 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Authorized official

Name
Victor Starr
Title
President/Ceo
Phone
(707) 826-8633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 010000340 CA Primary

Addresses

Primary practice location

1644 Central Avenue
Suite F
McKinleyville, CA 95519

Mailing address

1275 8TH St
Arcata, CA 95521-5770
Phone (707) 826-8633

Other identifiers 1

IdentifierTypeStateIssuer
FHC70779FMedicaidCA

Other names 1

  • McKinleyville Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030102000015 CA Part A Provider - Federally Qualified Health Center (FQHC) 9436067485 Practice locations: McKinleyville, CA
O20040414000890 CA Part B Supplier - Clinic/Group Practice 9436067485 Receives reassigned benefits from 211 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arcata, CA; Willow Creek, CA; McKinleyville, CA; Fortuna, CA; Ferndale, CA; Eureka, CA; Crescent City, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598858169. Details of each certification follow.

Federally qualified health center certification: CCN 551917

Legal name
OPEN DOOR COMMUNITY HEALTH CENTERS
Doing business as
MCKINLEYVILLE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 30, 2002
Last certification
Dec 30, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 18, 1971 in CA
Enrollment address
1644 Central Ave
Ste F
McKinleyville, CA 95519-4342

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
05D0964235McKinleyville Community Health Center1644 Central Avenue, McKinleyville, CA 95519Provider-performed microscopyJun 23, 2028

National Provider Directory

National Provider Directory

Locations

1644 Central Ave
Ste F
McKinleyville, CA 95519
Phone (707) 839-3068

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Victor a Starr Individual Corporate OfficerPresident and Executive Officer Jan 7, 2020
W-2 Managing EmployeePresident and Executive Officer Jan 7, 2020
Jay Molofsky Individual Corporate DirectorBoard Member Aug 26, 2019
John Driscoll Individual Corporate DirectorBoard Member Jul 26, 2021
Lindsay Righter Individual Corporate OfficerBoard Member Jan 1, 2012
Sarah Kerr Individual Corporate OfficerVice President of Operations North Jun 5, 2015
W-2 Managing EmployeeVice President of Operations North Jun 5, 2015
Felicia Oldfather Individual Corporate DirectorBoard Treasurer Nov 1, 2002
Kathleen Moxon Individual Corporate DirectorBoard President Jul 1, 1999
Neal Sanders Individual Corporate OfficerBoard Member Jan 1, 1998
Stacy Watkins Individual Corporate Director May 30, 2007
W-2 Managing Employee Mar 9, 2005
Sydney Fisher Larson Individual Corporate DirectorBoard President Jul 1, 1999
Connie E Stewart Individual Corporate OfficerBoard Member Mar 1, 2009
Alison Talbot Individual Corporate OfficerBoard Vice President Jan 1, 2013

Practitioners & affiliated clinicians

Practitioners 87

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 87

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1598858169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 8TH ST",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955215770",
            "telephone_number": "707-826-8633",
            "fax_number": "707-826-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 CENTRAL AVENUE",
            "address_2": "SUITE F",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "95519",
            "telephone_number": "707-839-3068",
            "fax_number": "707-839-3827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "STARR",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "707-826-8633"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "010000340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70779F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McKinleyville Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McKinleyville Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McKinleyville, CA

Sources for this page

Verify at the official NPI Registry.