NPIMap

Organization Active NPI

Fresno Community Hospital and Medical Center

Doing business as Community Rehabilitation Center - Leon S. Peters

  • Rehabilitation Hospital Unit
  • Fresno, CA
National Provider Identifier
1679654404
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
040000096 Issued in CA
Legal business name
FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
Doing business as
Community Rehabilitation Center - Leon S. Peters
Practice address
2823 Fresno St
Fresno, CA 93721-1324
Phone
(559) 459-2222
Fax
(559) 459-2575
NPI assigned
Oct 18, 2006
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY REGIONAL MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

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

Authorized official

Name
Mr. Craig Allen Wagoner
Title
Ceo
Phone
(559) 324-4266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 040000096 CA Primary

Addresses

Primary practice location

2823 Fresno St
Fresno, CA 93721-1324

Mailing address

PO Box 1232
Fresno, CA 93715-1232
Phone (559) 459-2222

Other names 1

  • Community Rehabilitation Center - Leon S. Peters Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120418000772 CA Part A Provider - Hospital 3173430865 Practice locations: Fresno, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679654404. Details of each certification follow.

Hospital certification: CCN 05T060

Legal name
FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 1945 in CA
Enrollment address
2823 Fresno St
Fresno, CA 93721-1324
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Leon S Peters RehabilationCCN 05T060 · All quality measures
Ownership
Non-profit
Certified
Sep 1, 1984

National Provider Directory

National Provider Directory
Tax ID family
Fresno Community Hospit22 organizations share this tax ID, including this one
Part of
Fresno Community Hospit

Other organizations with this tax ID 21

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

View all 21

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Keith B Boone Individual Corporate DirectorBoard Member Apr 3, 2018
Deborah P Moffett Individual Corporate OfficerVice Treasurer Jan 1, 2012
W-2 Managing EmployeeVice President, Finance Administ Jan 1, 2012
Operational/Managerial ControlVice Treasurer Jan 1, 2012
Susan M Abundis Individual Corporate DirectorBoard Member Jan 1, 2022
Gregory Carl Estep Individual Corporate DirectorBoard Member Jan 1, 2020
Roger E Sturdevant Individual Corporate OfficerChair Apr 12, 2023
Corporate DirectorBoard Member Jan 1, 2016
Craig Wagoner Individual Corporate OfficerChief Executive Officer Feb 3, 2025
W-2 Managing EmployeeChief Executive Officer Feb 3, 2025
Operational/Managerial ControlChief Executive Officer Feb 3, 2025
Gerardo Hernandez Individual Corporate DirectorBoard Member Jun 6, 2023
Nicholas David Dugan Individual Corporate DirectorBoard Member Feb 25, 2025
Mark J Coelho Individual Corporate DirectorBoard Member Feb 7, 2023
Fabiola Gonzalez Individual Corporate DirectorBoard Member May 20, 2025
Isabel D Martinez Individual Corporate OfficerVice Secretary Jan 1, 2023
Chandrasekar Venugopal Individual Corporate DirectorBoard Member Jan 1, 2016
Leland D Parnagian Individual Corporate DirectorBoard Member Feb 7, 2023
Christopher M Neuman Individual Corporate OfficerEvp Chief Finance & Adminis Officer Jan 1, 2023
W-2 Managing EmployeeEvp Chief Finance & Adminis Officer Jan 1, 2023
Operational/Managerial ControlEvp Chief Finance & Adminis Officer Jan 1, 2023
Lori Anne Bennett Individual Corporate DirectorBoard Member May 4, 2022
Community Hospitals of Central California Organization, Clovis, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 10, 1982 100%
Karen M McCaffrey Individual Corporate OfficerBoard Secretary Jan 1, 2023
Corporate DirectorBoard Member May 7, 2019

Owners & managing parties with NPI records 2

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

Facilities with the same owner 4

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1679654404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1232",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937151232",
            "telephone_number": "559-459-2222",
            "fax_number": "559-459-2575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211324",
            "telephone_number": "559-459-2222",
            "fax_number": "559-459-2575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY REGIONAL MEDICAL CENTER",
        "enumeration_date": "2006-10-18",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "WAGONER",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-324-4266",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "CA",
            "license": "040000096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Community Rehabilitation Center - Leon S. Peters",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Rehabilitation Center - Leon S. Peters",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.