Active NPI
St. Mary Medical Center
- General Acute Care Hospital
- Apple Valley, CA
National Provider Identifier
1710109186
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Acute Care Hospital
- License
- 240000207
- Legal business name
- ST. MARY MEDICAL CENTER
- Practice address
- 18300 US Highway 18
Apple Valley, CA 92307-2206 - Phone
- (760) 242-2311
- Fax
- (760) 946-8824
- NPI assigned
- May 3, 2007
- Organization subpart
- Yes
- Parent organization
- ST JOSEPH HEALTH SYSTEM
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Donald W Anderson Jr.
- Title
- Assistant Secretary Enrollments
- Phone
- (425) 358-9786
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 240000207 | CA | Primary |
Addresses
Primary practice location
18300 US Highway 18
Apple Valley, CA 92307-2206
Mailing address
18300 US Highway 18
Apple Valley, CA 92307-2206
Phone (760) 242-2311
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZT40300F | Medicaid | CA | |
| ZZT30300F | Medicaid | CA |
Other names 1
- Providence St. Mary Medical Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091230000214 | CA | Part A Provider - Hospital | 6002956893 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Apple Valley, CA |
Hospital certification: CCN 050300
- Legal name
- ST MARY MEDICAL CENTER
- Doing business as
- PROVIDENCE ST. MARY MEDICAL CENTER
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Mar 4, 2021
- Beds
- 212
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation
- Incorporated
- Dec 30, 1953 in CA
- Enrollment address
- 18300 US Highway 18
Apple Valley, CA 92307-2206 - Hospital subgroups
- General, Acute care
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Care Compare: Hospital
Medicare Care Compare- Listed as
- Providence St Mary Medical Center
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider Directory- Tax ID family
- St Mary Community Phcy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- General Acute Care Hospital
- Apple Valley, CA
- NPI 1669456299
Ownership & related parties
All disclosed owners & managing parties 21
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Adolph Collaso | Corporate Director | Aug 1, 2017 | |
| Viola Paulette Deters | Corporate Director | Jan 1, 2018 | |
| Zoheir R El-Hajjaoui | Corporate Director | Jan 1, 2014 | |
| Providence Health & Services - Washington | Operational/Managerial Control | Dec 1, 2020 | |
| John Paul Gostanian | Corporate Director | Jan 1, 2016 | |
| Clarence Burke | Corporate Director | Jan 1, 2019 | |
| Joshua Conely | Corporate Director | Feb 1, 2025 | |
| Derek G King | Corporate Director | Jan 1, 2022 | |
| James Martin | Corporate Officer | Jan 13, 2023 | |
| Judith Dugan | Corporate Director | Jan 1, 2018 | |
| St Mary Medical Center | 5% Or Greater Direct Ownership Interest | Dec 1, 2020 | 100% |
| Donald Wayne Anderson | Corporate Officer | Dec 1, 2020 | |
| Eileen Haubl | Corporate Officer | Jun 16, 2025 | |
| Gregory David Hoffman | Corporate Officer | Oct 1, 2020 | |
| Jason W Lamoreaux | Corporate Director | Jan 1, 2022 | |
| Prashanth V Kumar | Corporate Director | Jan 1, 2024 | |
| St. Joseph Health System | Other | Nov 3, 2009 | |
| Jovy Lynn V Yankaskas | Corporate Director | Jan 1, 2022 | |
| Randall Tuanqui Castillo | Corporate Officer | Aug 5, 2019 | |
| W-2 Managing Employee | Aug 5, 2019 | ||
| Margaret M Curran | Corporate Director | Jan 1, 2024 | |
| Providence St. Joseph Health | Other | Jul 1, 2016 |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Victorville, CA
- NPI 1831199058
Corporate Director
-
- Nephrology Physician
- Victorville, CA
- NPI 1821293382
Corporate Director
-
- General Acute Care Hospital
- Apple Valley, CA
- NPI 1669456299
5% Or Greater Direct Ownership Interest
Practitioners & affiliated clinicians
Affiliated clinicians 276
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Student in an Organized Health Care Education/Training Program
- Hemet, CA
- NPI 1306599097
Hospital
-
- Diagnostic Neuroimaging (Radiology) Physician
- Loma Linda, CA
- NPI 1992983282
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1746748800000",
"number": "1710109186",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18300 US HIGHWAY 18",
"city": "APPLE VALLEY",
"state": "CA",
"postal_code": "923072206",
"telephone_number": "760-242-2311",
"fax_number": "760-946-8824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18300 US HIGHWAY 18",
"city": "APPLE VALLEY",
"state": "CA",
"postal_code": "923072206",
"telephone_number": "760-242-2311",
"fax_number": "760-946-8824"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ST. MARY MEDICAL CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ST JOSEPH HEALTH SYSTEM",
"enumeration_date": "2007-05-03",
"last_updated": "2025-05-09",
"certification_date": "2025-05-09",
"status": "A",
"authorized_official_last_name": "ANDERSON",
"authorized_official_first_name": "DONALD",
"authorized_official_middle_name": "W",
"authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
"authorized_official_telephone_number": "425-358-9786",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": "CA",
"license": "240000207",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZT40300F",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZT30300F",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Providence St. Mary Medical Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Apple Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.