NPIMap

Organization Active NPI

Alliance Medical Center

  • Federally Qualified Health Center (FQHC)
  • Windsor, CA
National Provider Identifier
1710218409
Registry record updated Jul 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001284 Issued in CA
Legal business name
ALLIANCE MEDICAL CENTER
Practice address
8465 Old Redwood Hwy Ste 320
Windsor, CA 95492-9244
Phone
(707) 433-5494
Fax
(707) 385-2157
NPI assigned
Jan 20, 2010
Last updated
Jul 30, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2020

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

Authorized official

Name
Joan Churchill
Title
Ceo
Phone
(707) 385-2306

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550001284 CA Primary

Addresses

Primary practice location

8465 Old Redwood Hwy Ste 320
Windsor, CA 95492-9244

Mailing address

1381 University St
Healdsburg, CA 95448-3314
Phone (707) 433-5494

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100310000291 CA Part A Provider - Federally Qualified Health Center (FQHC) 3779471446 Practice locations: Windsor, CA
O20130128000264 CA Part B Supplier - Clinic/Group Practice 3779471446 Receives reassigned benefits from 51 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Healdsburg, CA; Windsor, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710218409. Details of each certification follow.

Federally qualified health center certification: CCN 551038

Legal name
ALLIANCE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 1, 2010
Last certification
Mar 1, 2010
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jan 10, 1978 in CA
Enrollment address
8465 Old Redwood Highway
Suite 320
Windsor, CA 95492-9244

Other NPIs with the same Medicare PAC ID 3

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.

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
05D2178256Alliance Medical Center - Windsor Site8465 Old Redwood Highway Suite 320, Windsor, CA 95492Certificate of waiverJan 28, 2028

National Provider Directory

National Provider Directory

Locations

1381 University St
Healdsburg, CA 95448
Phone (707) 431-8234

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Amy Fawcett Individual Corporate OfficerCfo Sep 25, 2023
W-2 Managing EmployeeCfo Sep 25, 2023
Jose Ramirez Individual Corporate DirectorBoard Member Feb 5, 2026
Nancy Nella Individual Corporate DirectorBoard Member Aug 1, 2023
Maryanne Harris Individual Corporate DirectorBoard Member Mar 6, 2025
Marilyn Murray Individual Corporate DirectorBoard Member Mar 5, 2026
William Leland Individual Corporate DirectorBoard Member Mar 6, 2025
Marisela Cervantes Individual Corporate DirectorBoard Member Dec 5, 2024
Timothy J Regan Individual Corporate DirectorBoard Member Jul 10, 2025
Susannah Rachael Labbe Individual Corporate OfficerCeo Jan 17, 2017
W-2 Managing EmployeeCeo Jan 17, 2017
Operational/Managerial ControlCeo Jul 1, 2022
Dena Cochran Individual Corporate DirectorChairperson Jul 1, 2022
Krystal Humphrey Individual Corporate DirectorTreasurer Feb 6, 2025
Emily Virgil Individual Corporate DirectorBoard Member Jan 4, 2024
Susan Lentz Individual Corporate DirectorBoard Member Nov 1, 2023
Theresa Mulvaney Individual Corporate DirectorBoard Member Jan 4, 2024
Kathryn Boyd Individual Corporate DirectorVice Chair Jan 2, 2025
Seth D Ammerman Individual Corporate DirectorBoard Member Jul 10, 2025

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 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1710218409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1381 UNIVERSITY ST",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954483314",
            "telephone_number": "707-433-5494",
            "fax_number": "707-431-8649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8465 OLD REDWOOD HWY STE 320",
            "city": "WINDSOR",
            "state": "CA",
            "postal_code": "954929244",
            "telephone_number": "707-433-5494",
            "fax_number": "707-385-2157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-20",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "CHURCHILL",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-385-2306"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Windsor, CA

Sources for this page

Verify at the official NPI Registry.