NPIMap

Organization Active NPI

Colusa Medical Center, LLC

Doing business as Colusa Medical Center - Hospice

  • Community Based Hospice Care Agency
  • Colusa, CA
National Provider Identifier
1689189110
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
COLUSA MEDICAL CENTER, LLC
Doing business as
Colusa Medical Center - Hospice
Progressive Hospice Care
Practice address
199 E Webster St
Colusa, CA 95932-2954
Phone
(530) 619-0800
Fax
(530) 619-0897
NPI assigned
Dec 6, 2017
Last updated
Jan 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Authorized official

Name
Tammy Jean Thompson
Title
VP Finance
Phone
(209) 248-7851

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X
Home Infusion Agency 251F00000X
Community Based Hospice Care Agency 251G00000X Primary
Inpatient Hospice 315D00000X

Addresses

Primary practice location

199 E Webster St
Colusa, CA 95932-2954

Mailing address

700 17TH St Ste 201D
Modesto, CA 95354-1249

Other names 2

  • Colusa Medical Center - Hospice Doing business as
  • Progressive Hospice Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180214001011 CA Part A Provider - Hospice 4183901978 Practice locations: Colusa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689189110. Details of each certification follow.

Hospice certification: CCN A01519

Legal name
COLUSA MEDICAL CENTER, LLC
Doing business as
COLUSA MEDICAL CENTER - HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 26, 2018
Last certification
Nov 26, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
199 E Webster St
Colusa, CA 95932-2954

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Colusa Medical Center HospiceCCN A01519 · All quality measures
Ownership
For-Profit
Certified
Nov 26, 2018
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Colusa Medical Center LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

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/Ceo Nov 16, 2016 100%
Jagraj S Nijjar Individual Contracted Managing EmployeeMD; Apr 25, 2017
Corporate DirectorMedical Director Apr 25, 2017
Shamsher Bhullar Individual Corporate OfficerCeo Jan 1, 2018
Corporate DirectorAdministrator Jan 1, 2018
Tammy Thompson Individual Corporate OfficerExecutive Vice President/Cfo May 1, 2017
Corporate DirectorExecutive Vice President/Cfo May 1, 2017
W-2 Managing EmployeeExecutive Vice President/Cfo May 1, 2017
Operational/Managerial ControlChief Financial Officer May 17, 2019

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 11

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Colusa Medical Center - AcuteColusa, CA, CCN 050783 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center-AcuteColusa, CA, CCN 05U783 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center - SNFColusa, CA, CCN 555909 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 1, 2019
Jun 27, 2018
Colusa Medical CenterWilliams, CA, CCN 058696 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical CenterArbuckle, CA, CCN 058695 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical CenterColusa, CA, CCN 058697 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center, LLCRed Bluff, CA, CCN 058722 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center, LLCOrland, CA, CCN 058720 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
First Care Medical AssociatesOrland, CA, CCN 058922 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Glenn Family Medical GroupWillows, CA, CCN 058572 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2025
Family Care CenterWillows, CA, CCN 053981 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2025

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1689189110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 17TH ST STE 201D",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953541249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 E WEBSTER ST",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "959322954",
            "telephone_number": "530-619-0800",
            "fax_number": "530-619-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUSA MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "209-248-7851"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colusa Medical Center - Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Progressive Hospice Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colusa, CA

Sources for this page

Verify at the official NPI Registry.