NPIMap

Organization Active NPI

Sutter West Bay Hospitals

Doing business as Sutter Lakeside Community Health Center

  • Rural Health Clinic/Center
  • Upper Lake, CA
National Provider Identifier
1629301775
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
110000094 Issued in CA
Legal business name
SUTTER WEST BAY HOSPITALS
Doing business as
Sutter Lakeside Community Health Center
Practice address
750 Old Lucerne Road
Upper Lake, CA 95485-0000
Phone
(707) 275-9066
Fax
(707) 275-9070
NPI assigned
Sep 8, 2009
Last updated
Jan 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
Mr. Brian Trent Hunter
Title
VP Shared Services
Phone
(916) 297-8555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 110000094 CA Primary

Addresses

Primary practice location

750 Old Lucerne Road
Upper Lake, CA 95485-0000

Mailing address

PO Box 742412
Los Angeles, CA 90074-2412
Phone (415) 600-7120

Other identifiers 1

IdentifierTypeStateIssuer
RKY18547FMedicaidCA

Other names 1

  • Sutter Lakeside Community Health Center Doing business as

National Provider Directory

National Provider Directory

Locations

750 Old Lucerne Rd
Upper Lake, CA 95485
Phone (707) 275-9066

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1629301775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742412",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900742412",
            "telephone_number": "415-600-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 OLD LUCERNE ROAD",
            "city": "UPPER LAKE",
            "state": "CA",
            "postal_code": "954850000",
            "telephone_number": "707-275-9066",
            "fax_number": "707-275-9070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER WEST BAY HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "HUNTER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "TRENT",
        "authorized_official_title_or_position": "VP SHARED SERVICES",
        "authorized_official_telephone_number": "916-297-8555",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "110000094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RKY18547F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter Lakeside Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sutter Lakeside Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upper Lake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.