NPIMap

Organization Active NPI

Mountain Valleys Health Centers

  • Federally Qualified Health Center (FQHC)
  • Mount Shasta, CA
National Provider Identifier
1629570320
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MOUNTAIN VALLEYS HEALTH CENTERS
Practice address
101 Old McCloud Rd
Mount Shasta, CA 96067-2796
Phone
(530) 999-9040
NPI assigned
Mar 8, 2018
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Brandon Watkins
Title
Cfo
Phone
(530) 999-9010

Other NPIs on the same Medicare enrollment 9

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

Other NPIs with the same Medicare PAC ID 8

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

Corporate family (same tax ID) 7

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

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050429000424 CA Part B Supplier - Clinic/Group Practice 4284685538 Receives reassigned benefits from 52 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dorris, CA; Weed, CA; Tulelake, CA; Mount Shasta, CA; Fall River Mills, CA; Burney, CA; Bieber, CA
O20180531001020 CA Part a Provider - Federally Qualified Health Center (FQHC) 4284685538 Practice locations: Mount Shasta, CA

Federally qualified health center certification: CCN 921068

Medicare enrollment files
Legal name
MOUNTAIN VALLEYS HEALTH CENTERS
Doing business as
MT. SHASTA HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 24, 2018
Last certification
Apr 24, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 16, 1981 in CA
Enrollment address
101 Old McCloud Rd
Mount Shasta, CA 96067-2796

All disclosed owners & managing parties 14

Medicare enrollment files

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

NameRoleSinceShare
Jana Blevins Individual Corporate DirectorBoard Member Nov 30, 2020
Edna Eades Individual Corporate DirectorBoard Member Jul 31, 2017
Shannon Gerig Individual Corporate OfficerCeo Aug 1, 2019
W-2 Managing EmployeeCeo Aug 1, 2019
Operational/Managerial ControlCeo Aug 1, 2019
John Hayes Individual Corporate DirectorBoard Member Oct 26, 2020
Susie Lorenzen Individual Corporate DirectorBoard Member Aug 31, 2020
Connie Voltura Individual Corporate DirectorBoard Member May 28, 2018
Lydia Hawkins Individual W-2 Managing EmployeeBilling Manager Mar 24, 2019
Becky Vaughan Individual Corporate DirectorBoard Member Feb 27, 2023
William James Billo Individual Corporate DirectorBoard Member Dec 1, 2016
Raul Figueroa Tamayo Individual Corporate DirectorBoard Member May 31, 2021
Brandon Watkins Individual Corporate OfficerCfo Mar 26, 2018
W-2 Managing EmployeeCfo Mar 26, 2018
Operational/Managerial ControlCfo Mar 26, 2018
Edwin Stokes Individual Corporate DirectorBoard Member Nov 30, 2020
Richard Fuentes Individual Corporate DirectorBoard Member Jan 5, 2011
Charlene Burgi Individual Corporate DirectorBoard Member May 28, 2018

National Provider Directory

National Provider Directory
Tax ID family
Big Valley Health Cente (8 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

101 Old McCloud Rd
Mount Shasta, CA 96067-2796

Mailing address

PO Box 277
Bieber, CA 96009-0277
Phone (530) 999-9010

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
1629570320MedicaidCA

Other names 1

NPPES NPI Registry
  • Mount Shasta Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 28, 2023.

{
    "created_epoch": "1520467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690502400000",
    "number": "1629570320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277",
            "city": "BIEBER",
            "state": "CA",
            "postal_code": "960090277",
            "telephone_number": "530-999-9010",
            "fax_number": "530-294-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 OLD MCCLOUD RD",
            "city": "MOUNT SHASTA",
            "state": "CA",
            "postal_code": "960672796",
            "telephone_number": "530-999-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN VALLEYS HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-08",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A",
        "authorized_official_last_name": "WATKINS",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "530-999-9010"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629570320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Shasta Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Shasta, CA

Sources for this page

Verify at the official NPI Registry.