NPIMap

Organization Active NPI

Riverside Health Clinic of Colusa

  • Internal Medicine Physician
  • Colusa, CA
National Provider Identifier
1710172242
Registry record updated Nov 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A51440 Issued in CA
Legal business name
RIVERSIDE HEALTH CLINIC OF COLUSA
Practice address
717 Bridge St
Colusa, CA 95932-2851
Phone
(530) 458-2300
Fax
(530) 458-5558
NPI assigned
Sep 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2019

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

Authorized official

Name
Sanjiv K Midha, M.D.NPI 1265476014
Title
Physician
Phone
(530) 458-2300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A51440 CA Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X A70328 CA

Addresses

Primary practice location

717 Bridge St
Colusa, CA 95932-2851

Mailing address

1215 Plumas St
Suite 1900
Yuba City, CA 95991-3455
Phone (530) 674-2100

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071101000674 CA Part A Provider - Rural Health Clinic 7719074046 Practice locations: Colusa, CA
O20071220000533 CA Part B Supplier - Clinic/Group Practice 7719074046 Receives reassigned benefits from 8 practitioners
Practice locations: Colusa, CA

Rural health clinic certification: CCN 058912

Legal name
RIVERSIDE HEALTH CLINIC OF COLUSA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 27, 2006
Last certification
Apr 16, 2019
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jul 27, 2007 in CA
Enrollment address
717 Bridge St
Colusa, CA 95932-2851

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
05D1080343Riverside Health Clinic of Colusa Inc717 Bridge Street, Colusa, CA 95932Certificate of waiverFeb 19, 2028

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Yash G Brar Individual 5% Or Greater Direct Ownership Interest Mar 28, 2008
Sanjiv Midha Individual 5% Or Greater Direct Ownership Interest Mar 28, 2005 50%
W-2 Managing Employee Apr 1, 2015

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573689600000",
    "number": "1710172242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 PLUMAS ST",
            "address_2": "SUITE 1900",
            "city": "YUBA CITY",
            "state": "CA",
            "postal_code": "959913455",
            "telephone_number": "530-674-2100",
            "fax_number": "530-674-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 BRIDGE ST",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "959322851",
            "telephone_number": "530-458-2300",
            "fax_number": "530-458-5558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE HEALTH CLINIC OF COLUSA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2019-11-14",
        "status": "A",
        "authorized_official_last_name": "MIDHA",
        "authorized_official_first_name": "SANJIV",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "530-458-2300",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A51440",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A70328",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colusa, CA

Sources for this page

Verify at the official NPI Registry.