NPIMap

Organization Active NPI

Round Valley Indian Health Center, Inc.

  • Clinic/Center
  • Covelo, CA
National Provider Identifier
1669532750
Registry record updated Mar 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
110000097 Issued in CA
Legal business name
ROUND VALLEY INDIAN HEALTH CENTER, INC.
Practice address
24065 Biggar Lane
Covelo, CA 95428-0247
Phone
(707) 983-6404
Fax
(707) 983-6184
NPI assigned
Dec 11, 2006
Last updated
Mar 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2024

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

Authorized official

Name
Otis D Brotherton
Title
Executive Director
Phone
(707) 983-6181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 110000097 CA Primary

Addresses

Primary practice location

24065 Biggar Lane
Covelo, CA 95428-0247

Mailing address

PO Box 247
Covelo, CA 95428-0247
Phone (707) 983-6404

Other identifiers 1

IdentifierTypeStateIssuer
THP11697FMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507001316 CA Part B Supplier - Clinic/Group Practice 9234128927 Receives reassigned benefits from 35 practitioners
Practice locations: Covelo, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710374400000",
    "number": "1669532750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 247",
            "city": "COVELO",
            "state": "CA",
            "postal_code": "954280247",
            "telephone_number": "707-983-6404",
            "fax_number": "707-983-6184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24065 BIGGAR LANE",
            "city": "COVELO",
            "state": "CA",
            "postal_code": "954280247",
            "telephone_number": "707-983-6404",
            "fax_number": "707-983-6184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROUND VALLEY INDIAN HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2024-03-14",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "BROTHERTON",
        "authorized_official_first_name": "OTIS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-983-6181"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "110000097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "THP11697F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covelo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.