Open Door Community Health Centers
Organization Active NPI Federally Qualified Health Center (FQHC) · Arcata, CA
NPI 1689206252 · NPPES record last updated Jun 7, 2023
Key facts
- NPI
- 1689206252
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- OPEN DOOR COMMUNITY HEALTH CENTERS
- Practice address
- 3770 Janes Rd
Arcata, CA 95521-4744 - Phone
- (707) 825-7588
- NPI assigned
- Feb 11, 2020
- Organization subpart
- Yes
- Parent organization (as reported)
- OPEN DOOR COMMUNITY HEALTH CENTERS
Authorized official
- Name
- Stacy Watkins
- Title
- Chief Administrative Officer
- Phone
- (707) 826-8633
Other NPIs on the same Medicare enrollment 12
Practitioners 3
-
Steven Elais Aussenberg, M.D.
-
Amita R Khazanie, MD
-
Molly A Lalonde, CPNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040414000890 | CA | Part B Supplier - Clinic/Group Practice | 9436067485 |
Receives reassigned benefits from 211 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Arcata, CA; Willow Creek, CA; McKinleyville, CA; Fortuna, CA; Ferndale, CA; Eureka, CA; Crescent City, CA |
National Provider Directory
- Part of
- Smith River Community
Locations
3750 Rohnerville Rd
Fortuna, CA 95540
Phone (707) 725-4477
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
3770 Janes Rd
Arcata, CA 95521-4744
Mailing address
1275 8TH St
Arcata, CA 95521-5770
Phone (707) 826-8633
Other names
- Open Door Gynecology Services
NPI Registry JSON
{
"created_epoch": "1581379200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1686096000000",
"number": "1689206252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1275 8TH ST",
"city": "ARCATA",
"state": "CA",
"postal_code": "955215770",
"telephone_number": "707-826-8633",
"fax_number": "707-826-8638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3770 JANES RD",
"city": "ARCATA",
"state": "CA",
"postal_code": "955214744",
"telephone_number": "707-825-7588"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OPEN DOOR COMMUNITY HEALTH CENTERS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "OPEN DOOR COMMUNITY HEALTH CENTERS",
"enumeration_date": "2020-02-11",
"last_updated": "2023-06-07",
"certification_date": "2023-06-07",
"status": "A",
"authorized_official_last_name": "WATKINS",
"authorized_official_first_name": "STACY",
"authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
"authorized_official_telephone_number": "707-826-8633"
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Open Door Gynecology Services",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Arcata, CA
- Teresa Oliveri
- Elizabeth Catherine Olson
- Eric Alan Olson
- Open Door Community Health Centers
- Open Door Community Health Centers
- Open Door Community Health Centers
- Open Door Community Health Centers
- Open Door Community Health Centers
- Openmind Connections LLC
- Alyssa Ortega
All providers in Arcata, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.