NPIMap

Organization Active NPI

Open Door Community Health Centers

Doing business as Open Door Gynecology Services

  • Federally Qualified Health Center (FQHC)
  • Arcata, CA
National Provider Identifier
1689206252
Registry record updated Jun 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OPEN DOOR COMMUNITY HEALTH CENTERS
Doing business as
Open Door Gynecology Services
Practice address
3770 Janes Rd
Arcata, CA 95521-4744
Phone
(707) 825-7588
NPI assigned
Feb 11, 2020
Last updated
Jun 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
OPEN DOOR COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2023

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

Authorized official

Name
Stacy Watkins
Title
Chief Administrative Officer
Phone
(707) 826-8633

Specialties & licenses 1

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

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 1

  • Open Door Gynecology Services Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689206252. Details of each certification follow.

  • CCN 921816 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921816

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
OPEN DOOR GYNECOLOGY SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 13, 2020
Last certification
Apr 13, 2020
Ownership / control type
For profit – corporation
Facility address
3770 Janes Rd
Arcata, CA 95521

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory
Part of
Open Door Community Health Centers

Locations

3750 Rohnerville Rd
Fortuna, CA 95540
Phone (707) 725-4477

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.

NPI Registry JSON

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

{
    "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

Sources for this page

Verify at the official NPI Registry.