NPIMap

Organization Active NPI

Sutter Coast Hospital

Doing business as Sutter Coast Community Clinic

  • General Practice Physician
  • Crescent City, CA
National Provider Identifier
1700960267
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
SUTTER COAST HOSPITAL
Doing business as
Sutter Coast Community Clinic
Practice address
780 E Washington Blvd
Suite 202
Crescent City, CA 95531-8397
Phone
(707) 464-6715
Fax
(707) 465-0870
NPI assigned
Oct 24, 2006
Last updated
Oct 10, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
SUTTER COAST HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Mitch Hanna
Title
Ceo
Phone
(707) 464-8880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

780 E Washington Blvd
Suite 202
Crescent City, CA 95531-8397

Mailing address

800 E Washington Blvd
Crescent City, CA 95531-8359
Phone (707) 464-8511

Other names 1

  • Sutter Coast Community Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040827000424 CA Part B Supplier - Clinic/Group Practice 9436148111 Receives reassigned benefits from 37 practitioners
1 other NPI on this enrollment
Practice locations: Crescent City, CA
O20071220000107 CA Part A Provider - Hospital 9436148111 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brookings, OR; Crescent City, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700960267. Details of each certification follow.

Hospital certification: CCN 050417

Legal name
SUTTER COAST HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 15, 2025
Beds
49
Ownership / control type
Hospital district or authority
Most recent change of ownership
Feb 1, 1986 (2 total)
Organization structure
CorporationNon-profit
Incorporated
May 23, 1985 in CA
Enrollment address
800 E Washington Blvd
Crescent City, CA 95531-8359
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Sutter Coast HospitalCCN 050417 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1061960Sutter Coast Community Clinic780 E Washington Blvd, Crescent City, CA 95531Certificate of waiverFeb 28, 2028

National Provider Directory

National Provider Directory
Part of
Anthony Demory MD

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

780 E Washington Blvd
Ste 202
Crescent City, CA 95531
Phone (707) 464-6715

780 E Washington Blvd
Ste 302
Crescent City, CA 95531

785 E Washington Blvd
Ste 202
Crescent City, CA 95531

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Patricia Piper Individual Corporate Director Dec 1, 2018
Michael Lane Individual Corporate OfficerCeo Feb 5, 2024
Ronnie Yamanaka Individual Corporate OfficerCfo Jan 4, 2024
W-2 Managing Employee Jan 4, 2024
John Pritchett Individual Corporate Director Nov 1, 2023
Carroll C Christie Individual Corporate Director Jan 1, 2019
Celia Perez Individual Corporate Director Sep 1, 2021
Clarke Moore Individual Corporate Director Jan 1, 2017
Ronald Sandler Individual Corporate Director Feb 1, 2018
Sutter Health Organization, Sacramento, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 31, 1986 100%
Roland Hart Individual Corporate Director May 1, 2019

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Sutter Coast Health CenterCrescent City, CA, CCN 058519 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 31, 1986

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 40

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 40

Affiliated clinicians 197

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

View all 197

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1700960267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318359",
            "telephone_number": "707-464-8511",
            "fax_number": "707-464-8886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 E WASHINGTON BLVD",
            "address_2": "SUITE 202",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318397",
            "telephone_number": "707-464-6715",
            "fax_number": "707-465-0870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER COAST HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUTTER COAST HOSPITAL",
        "enumeration_date": "2006-10-24",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "HANNA",
        "authorized_official_first_name": "MITCH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-464-8880"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter Coast Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crescent City, CA

Sources for this page

Verify at the official NPI Registry.