NPIMap

Organization Active NPI

Alliance Medical Center

  • Federally Qualified Health Center (FQHC)
  • Healdsburg, CA
National Provider Identifier
1750399796
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
110000096 Issued in CA
Legal business name
ALLIANCE MEDICAL CENTER
Practice address
1381 University St
Healdsburg, CA 95448-3314
Phone
(707) 433-5494
Fax
(707) 431-8649
NPI assigned
Aug 4, 2006
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 110000096 CA Primary

Addresses

Primary practice location

1381 University St
Healdsburg, CA 95448-3314

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
FHC03923FMedicaidCA

Other names 1

  • Alliance Medical Center - Healdsburg Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326000411 CA Part A Provider - Federally Qualified Health Center (FQHC) 3779471446 Practice locations: Healdsburg, CA
O20130128000264 CA Part B Supplier - Clinic/Group Practice 3779471446 Receives reassigned benefits from 51 practitioners
1 other NPI on this enrollment
Practice locations: Healdsburg, CA; Windsor, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750399796. Details of each certification follow.

Federally qualified health center certification: CCN 551806

Legal name
ALLIANCE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1996
Last certification
Jul 1, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 8, 1975 in CA
Enrollment address
1381 University St
Healdsburg, CA 95448-3314

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.

National Provider Directory

National Provider Directory

Locations

1557 Healdsburg Ave
Ste 16
Healdsburg, CA 95448

625 Center St
Healdsburg, CA 95448

144 Stony Point Rd
Santa Rosa, CA 95401
Phone (707) 521-4500

8465 Old Redwood Hwy
Windsor, CA 95492
Phone (707) 431-1170

8465 Old Redwood Hwy
Ste 300
Windsor, CA 95492

8499 Old Redwood Hwy
Ste 112
Windsor, CA 95492

Ownership & related parties

All disclosed owners & managing parties 18

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 Employee Jan 17, 2017
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
Deena Trucco Individual Corporate DirectorDirector of Human Resources Jan 30, 2020 100%
W-2 Managing EmployeeDirector of Human Resources Jan 30, 2020 100%
Francisco Soto Individual OtherCredentialing Coordinator Jan 30, 2020 100%
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 64

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 64

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1750399796",
    "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": "1381 UNIVERSITY ST",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954483314",
            "telephone_number": "707-433-5494",
            "fax_number": "707-431-8649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "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": "110000096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03923F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Alliance Medical Center - Healdsburg",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Healdsburg, CA

Sources for this page

Verify at the official NPI Registry.