NPIMap

Organization Active NPI

Vanguard Medical Corporation

Doing business as Shafter Rural Healthcare Clinic

  • Rural Health Clinic/Center
  • Shafter, CA
National Provider Identifier
1609281310
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
VANGUARD MEDICAL CORPORATION
Doing business as
Shafter Rural Healthcare Clinic
Practice address
565 Kern St
Shafter, CA 93263-2133
Phone
(661) 746-4937
NPI assigned
Jun 23, 2014
Last updated
May 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Authorized official

Name
Novira Sunner
Title
Manager
Phone
(661) 599-5310

Specialties & licenses 1

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

Addresses

Primary practice location

565 Kern St
Shafter, CA 93263-2133

Mailing address

565 Kern St
Shafter, CA 93263-2133

Other names 1

  • Shafter Rural Healthcare Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140813002697 CA Part B Supplier - Clinic/Group Practice 4587881685 Receives reassigned benefits from 33 practitioners
4 other NPIs on this enrollment
Practice locations: Arvin, CA; Bakersfield, CA; Shafter, CA; Wasco, CA
O20150306002108 CA Part A Provider - Rural Health Clinic 4587881685 Practice locations: Shafter, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609281310. Details of each certification follow.

Rural health clinic certification: CCN 553819

Legal name
VANGUARD MEDICAL CORPORATION
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 22, 1994
Last certification
Feb 10, 2014
Ownership / control type
1A
Most recent change of ownership
Jul 1, 2014 (1 total)
Organization structure
CorporationProprietary
Incorporated
Apr 30, 2014 in CA
Enrollment address
565 Kern St
Shafter, CA 93263-2133

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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
05D0723619Vanguard Medical Corporation565 Kern Street, Shafter, CA 93263Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Novira P Sunner Individual W-2 Managing EmployeeClinic Administrator Apr 30, 2014
Chan Park Individual 5% Or Greater Direct Ownership Interest Apr 30, 2014 100%
Corporate OfficerCeo/Cfo/Secretary Apr 30, 2014 100%
Corporate DirectorDirector Apr 30, 2014 100%

Owners & managing parties with NPI records 1

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

  • Chan H. Park, M.D.
    • Family Medicine Physician
    • Shafter, CA
    • NPI 1255336665

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1403481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777593600000",
    "number": "1609281310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "565 KERN ST",
            "city": "SHAFTER",
            "state": "CA",
            "postal_code": "932632133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 KERN ST",
            "city": "SHAFTER",
            "state": "CA",
            "postal_code": "932632133",
            "telephone_number": "661-746-4937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANGUARD MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-23",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A",
        "authorized_official_last_name": "SUNNER",
        "authorized_official_first_name": "NOVIRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "661-599-5310"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shafter Rural Healthcare Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shafter, CA

Sources for this page

Verify at the official NPI Registry.