NPIMap

Organization Active NPI

Open Door Community Health Centers

Doing business as Willow Creek Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Willow Creek, CA
National Provider Identifier
1730330739
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
Willow Creek Community Health Center
Practice address
38883 Highway 299
Willow Creek, CA 95573-0726
Phone
(530) 629-3111
Fax
(530) 629-3122
NPI assigned
Oct 8, 2008
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
Cheyenne Spetzler
Title
Coo
Phone
(707) 826-8633

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Obstetrics Physician 207VX0000X

Addresses

Primary practice location

38883 Highway 299
Willow Creek, CA 95573-0726

Mailing address

1275 8TH St
Arcata, CA 95521-5770
Phone (707) 826-8633

Other identifiers 1

IdentifierTypeStateIssuer
1730330739MedicaidCA

Other names 1

  • Willow Creek Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

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
O20090108000083 CA Part A Provider - Federally Qualified Health Center (FQHC) 9436067485 Practice locations: Willow Creek, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730330739. Details of each certification follow.

Federally qualified health center certification: CCN 051146

Legal name
OPEN DOOR COMMUNITY HEALTH CENTERS
Doing business as
WILLOW CREEK COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 29, 2009
Last certification
Jan 29, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 18, 1971 in CA
Enrollment address
38883 Highway 299
Willow Creek, CA 95573-0726

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 12

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
05D1091695Willow Creek Community Health Center38883 Highway 299, Willow Creek, CA 95573Provider-performed microscopyNov 5, 2026

National Provider Directory

National Provider Directory
Part of
Del Norte Community Hea

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 13

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

NameRoleSinceShare
Victor a Starr Individual Corporate OfficerCeo Jan 7, 2020
W-2 Managing EmployeeCeo Jan 7, 2020
Dino Novello Individual Corporate DirectorBoard Member Sep 25, 2023
Jay Molofsky Individual Corporate DirectorBoard President Aug 26, 2019
John Driscoll Individual Corporate DirectorBoard Member Jul 26, 2021
Felicia Oldfather Individual Corporate DirectorBoard Member Jan 1, 2002
Stephanie Boers Individual Corporate DirectorBoard Vice President Sep 22, 2022
Kathleen Moxon Individual Corporate DirectorBoard Member Jul 1, 1999
Keith Flamer Individual Corporate DirectorBoard Member Nov 1, 2022
Stacy Watkins Individual Corporate OfficerChief Administrative Nov 4, 2019
W-2 Managing Employee Dec 17, 2001
Lauren Mickelson Individual Corporate DirectorBoard Member Jan 1, 2025
Sarah Ross Individual Corporate OfficerChief Operations Officer Jan 6, 2026
W-2 Managing Employee Aug 31, 2016
Sydney Fisher Larson Individual Corporate DirectorBoard Member Jul 1, 1999
Alison Talbot Individual Corporate DirectorBoard Member Jan 1, 2013

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1223424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1730330739",
    "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": "38883 HIGHWAY 299",
            "city": "WILLOW CREEK",
            "state": "CA",
            "postal_code": "955730726",
            "telephone_number": "530-629-3111",
            "fax_number": "530-629-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPEN DOOR COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OPEN DOOR COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2008-10-08",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "SPETZLER",
        "authorized_official_first_name": "CHEYENNE",
        "authorized_official_title_or_position": "COO",
        "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
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730330739",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Creek Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Willow Creek Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willow Creek, CA

Sources for this page

Verify at the official NPI Registry.