NPIMap

Organization Active NPI

American Hospital Management Corporation

Doing business as Mad River Community Hospital

  • Rural Health Clinic/Center
  • Arcata, CA
National Provider Identifier
1609979707
Registry record updated Sep 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
PENDING
Legal business name
AMERICAN HOSPITAL MANAGEMENT CORPORATION
Doing business as
Mad River Community Hospital
Practice address
3800 Janes Rd
Arcata, CA 95521-4742
Phone
(707) 822-3621
NPI assigned
Sep 6, 2006
Last updated
Sep 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2019

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

Authorized official

Name
Douglas Allen Shaw
Title
Chief Executive Officer
Phone
(707) 822-7220

Specialties & licenses 1

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

Addresses

Primary practice location

3800 Janes Rd
Arcata, CA 95521-4742

Mailing address

PO Box 1115
Arcata, CA 95518-1115
Phone (707) 822-3621

Other names 2

  • MAD RIVER COMMUNITY HOSPITAL Doing business as
  • MAD RIVER EXPRESS CARE Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041209000674 CA Part B Supplier - Clinic/Group Practice 1052305331 Receives reassigned benefits from 11 practitioners
Practice locations: Arcata, CA
O20060908000524 CA Part A Provider - Rural Health Clinic 1052305331 Practice locations: Arcata, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609979707. Details of each certification follow.

Rural health clinic certification: CCN 058627

Legal name
AMERICAN HOSPITAL MANAGEMENT CORPORATION
Doing business as
MAD RIVER COMMUNITY HOSPITAL
Organization structure
CorporationProprietary
Incorporated
Jun 6, 1955 in CA
Enrollment address
3800 Janes Rd
Arcata, CA 95521-4742

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Member organizations 3

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

Locations

3798 Janes Rd
Ste 14
Arcata, CA 95521
Phone (707) 822-0293

3798 Janes Rd
Ste 3
Arcata, CA 95521
Phone (707) 826-2222

3798 Janes Rd
Ste 6
Arcata, CA 95521
Phone (707) 825-2663

3800 Janes Rd
Ste 6
Arcata, CA 95521
Phone (707) 822-3621

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Stephen Paine Individual Corporate DirectorBoard Member Jun 15, 2003
Shahram Abbassi Individual Corporate DirectorBoard Member Jun 18, 2018
American Hospital Management Corporation Organization, Arcata, CA Corporation, Medical provider/supplier, For-profit Operational/Managerial Control Aug 31, 2006 100%
Laura McMahon Individual W-2 Managing Employee Sep 30, 2018
Loretta Sands Individual Corporate DirectorBoard Member Jun 18, 2018
Doug a Shaw Individual Corporate OfficerCeo/Administrator Aug 31, 2006
Corporate DirectorBoard Member Aug 31, 2006 100%

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Humboldt Family Medical CenterMcKinleyville, CA, CCN 058505 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 6, 1995
Jun 6, 1995

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1609979707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1115",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955181115",
            "telephone_number": "707-822-3621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 JANES RD",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955214742",
            "telephone_number": "707-822-3621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN HOSPITAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-822-7220"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MAD RIVER COMMUNITY HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MAD RIVER EXPRESS CARE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Arcata, CA

Sources for this page

Verify at the official NPI Registry.