NPIMap

Organization Active NPI

Colusa Medical Center, LLC

  • Rural Health Clinic/Center
  • Arbuckle, CA
National Provider Identifier
1770084808
Registry record updated Jan 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COLUSA MEDICAL CENTER, LLC
Practice address
900 King Street
Arbuckle, CA 95912
Phone
(530) 619-0800
Fax
(530) 619-0897
NPI assigned
Feb 23, 2018
Last updated
Jan 28, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
COLUSA MEDICAL CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 28, 2020

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

Authorized official

Name
Tammy Jean Thompson
Title
VP Finance
Phone
(209) 248-7851

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

900 King Street
Arbuckle, CA 95912

Mailing address

700 17TH St Ste 201D
Modesto, CA 95354-1249

Other names 1

  • Arbuckle Health Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180724000865 CA Part A Provider - Rural Health Clinic 4183901978 Practice locations: Arbuckle, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770084808. Details of each certification follow.

Rural health clinic certification: CCN 058695

Legal name
COLUSA MEDICAL CENTER, LLC
Doing business as
COLUSA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 25, 2016
Last certification
Oct 25, 2016
Ownership / control type
2B
Most recent change of ownership
Aug 1, 2018 (1 total)
Organization structure
LLCProprietary
Enrollment address
900 King Street
Arbuckle, CA 95912
Related CCNs
050783

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 11

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

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
05D2116048Arbuckle Health Clinic900 King St, Arbuckle, CA 95912Certificate of waiverJul 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
Colusa Medical Center LLC10 organizations share this tax ID, including this one
Part of
Colusa Medical Center LLC

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Gurpreet Singh Randhawa Individual 5% Or Greater Direct Ownership Interest Aug 1, 2018 100%
Corporate OfficerBoard Member Aug 1, 2018 100%
Colusa Medical Center, LLC Organization, Orland, CA For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2019 100%
Tammy Thompson Individual Corporate OfficerVP/Cfo Aug 1, 2018
Corporate DirectorVP of Financing Aug 1, 2018
W-2 Managing EmployeeVP of Financing Aug 1, 2018

Owners & managing parties with NPI records 12

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

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Colusa Medical Center - AcuteColusa, CA, CCN 050783 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center-AcuteColusa, CA, CCN 05U783 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center - SNFColusa, CA, CCN 555909 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 1, 2019
Jun 27, 2018
Colusa Medical CenterWilliams, CA, CCN 058696 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical CenterColusa, CA, CCN 058697 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center, LLCRed Bluff, CA, CCN 058722 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center, LLCOrland, CA, CCN 058720 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
First Care Medical AssociatesOrland, CA, CCN 058922 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Glenn Family Medical GroupWillows, CA, CCN 058572 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2025
Family Care CenterWillows, CA, CCN 053981 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2025

Owned or controlled facilities with NPI records 9

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 1

DateEventCounterparty
Aug 1, 2018 Change of OwnershipThis provider was the buyer Adventist Health Clear LakeCCN 058695, CA, NPI 1215383047

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1519344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580169600000",
    "number": "1770084808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 17TH ST STE 201D",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953541249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 KING STREET",
            "city": "ARBUCKLE",
            "state": "CA",
            "postal_code": "95912",
            "telephone_number": "530-619-0800",
            "fax_number": "530-619-0897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUSA MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUSA MEDICAL CENTER, LLC",
        "enumeration_date": "2018-02-23",
        "last_updated": "2020-01-28",
        "certification_date": "2020-01-28",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "209-248-7851"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Arbuckle Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Arbuckle, CA

Sources for this page

Verify at the official NPI Registry.