NPIMap

Organization Active NPI

Glenn Medical Center, LLC

Doing business as Glenn Medical Center

  • Critical Access Hospital
  • Willows, CA
National Provider Identifier
1619929759
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
23000001 Issued in CA
Legal business name
GLENN MEDICAL CENTER, LLC
Practice address
1133 W. Sycamore Street
Willows, CA 95988-2601
Phone
(530) 934-1800
Fax
(530) 934-1865
NPI assigned
May 17, 2006
Last updated
Nov 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Authorized official

Name
Tammy Thompson
Title
Cfo/VP Finance
Phone
(209) 287-6308

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 23000001 CA
Critical Access Hospital 282NC0060X 23000001 CA Primary

Addresses

Primary practice location

1133 W. Sycamore Street
Willows, CA 95988-2601

Mailing address

1133 W. Sycamore Street
Willows, CA 95988-2601
Phone (530) 934-1800

Other identifiers 4

IdentifierTypeStateIssuer
HSP30092JMedicaidCA
HSP40092JMedicaidCA
RHM13981HMedicaidCA
RHM08572GMedicaidCA

Other names 1

  • GLENN MEDICAL CENTER Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210909002556 CA Part A Provider - Critical Access Hospital 4486050838 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
Practice locations: Willows, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619929759. Details of each certification follow.

Hospital certification: CCN 051306

Legal name
GLENN MEDICAL CENTER, LLC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 23, 2001
Last certification
Jan 11, 2024
Beds
47
Ownership / control type
Private (for profit)
Most recent change of ownership
Jul 1, 2021 (2 total)
Organization structure
LLCProprietary
Incorporated
Aug 7, 2019 in CA
Enrollment address
1133 W Sycamore St
Willows, CA 95988-2601
Main/Primary Hospital Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Glenn Medical CenterCCN 051306 · All quality measures
Type
Critical Access Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Glenn Medical Center LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

801 N Tustin Ave
Ste 605
Santa Ana, CA 92705
Phone (714) 584-9930

5001 Statesman Dr
Irving, TX 75063
Phone (469) 524-1506

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Gurpreet Singh Randhawa Individual 5% Or Greater Direct Ownership InterestOwner/Member Aug 7, 2019 100%
Shamsher Bhullar Individual Corporate OfficerAdministrator Jul 1, 2021
W-2 Managing EmployeeAdministrator Jul 1, 2021
Operational/Managerial ControlBoard Member Aug 7, 2019
Tammy Thompson Individual Contracted Managing EmployeeGoverning Board Secretary Aug 7, 2019
Corporate OfficerChief Financial Officer Jul 1, 2021
Corporate DirectorExecutive VP Finance Aug 7, 2019
Rumeet Kaur Randhawa Individual W-2 Managing EmployeeAssistant Administrator Mar 25, 2021

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 249

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 249

Affiliated clinicians 22

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1619929759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 W. SYCAMORE STREET",
            "city": "WILLOWS",
            "state": "CA",
            "postal_code": "959882601",
            "telephone_number": "530-934-1800",
            "fax_number": "530-934-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 W. SYCAMORE STREET",
            "city": "WILLOWS",
            "state": "CA",
            "postal_code": "959882601",
            "telephone_number": "530-934-1800",
            "fax_number": "530-934-1865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "CFO/VP FINANCE",
        "authorized_official_telephone_number": "209-287-6308"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "23000001",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "CA",
            "license": "23000001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP30092J",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40092J",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM13981H",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM08572G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLENN MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GLENN MEDICAL CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "GLENN MEDICAL CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Willows, CA

Sources for this page

Verify at the official NPI Registry.