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American Hospital Management Corporation

Organization Active NPI Rural Health Clinic/Center · Arcata, CA

NPI 1609979707 · NPPES record last updated Sep 20, 2019

Key facts

NPI
1609979707
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
PENDING
Legal business name
AMERICAN HOSPITAL MANAGEMENT CORPORATION
Practice address
3800 Janes Rd
Arcata, CA 95521-4742
Phone
(707) 822-3621
NPI assigned
Sep 6, 2006
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 1

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

Member organizations 3

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

Facilities with the same owner 1

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

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 37

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

Rural health clinic certification: CCN 058627

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

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 Director
Board Member		 Jun 15, 2003
Shahram Abbassi
Individual 		Corporate Director
Board 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 Director
Board Member		 Jun 18, 2018
Doug a Shaw
Individual 		Corporate Officer
Ceo/Administrator		 Aug 31, 2006
Corporate Director
Board Member		 Aug 31, 2006 100%

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 Center
McKinleyville, CA · CCN 058505		 Rural health clinic 5% Or Greater Indirect Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 6, 1995
Jun 6, 1995

Medicare enrollment records

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

National Provider Directory

Locations

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

3798 Janes Rd
Ste 14
Arcata, CA 95521
Phone (707) 822-3621

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

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
1609979707MedicaidCA

Other names

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

Other providers in Arcata, CA

All providers in Arcata, CA · Rural Health Clinic/Center in California

Sources for this page

Verify at the official NPI Registry.