NPIMap

Organization Active NPI

Sutter Bay Hospitals

  • Rural Health Clinic/Center
  • Lakeport, CA
National Provider Identifier
1770816829
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
110000094 Issued in CA
Legal business name
SUTTER BAY HOSPITALS
Practice address
5176 Hill Rd E
Lakeport, CA 95453-6300
Phone
(707) 262-5000
Fax
(707) 262-5003
NPI assigned
Sep 8, 2009
Last updated
Jan 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

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

Authorized official

Name
John B. Gates
Title
Cfo
Phone
(510) 450-7357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 110000094 CA Primary

Addresses

Primary practice location

5176 Hill Rd E
Lakeport, CA 95453-6300

Mailing address

PO Box 742412
Los Angeles, CA 90074-2412
Phone (415) 600-7120

Other identifiers 1

IdentifierTypeStateIssuer
RKY13994FMedicaidCA

Other names 1

  • Sutter West Bay Hospitals Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050517000547 CA Part B Supplier - Clinic/Group Practice 3476506528 Receives reassigned benefits from 144 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Castro Valley, CA; Santa Rosa, CA; San Leandro, CA; San Francisco, CA; Oakland, CA; Lakeport, CA; Berkeley, CA; Burlingame, CA…
O20091028000711 CA Part A Provider - Rural Health Clinic 3476506528 Practice locations: Lakeport, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770816829. Details of each certification follow.

Rural health clinic certification: CCN 553994

Legal name
SUTTER BAY HOSPITALS
Doing business as
SUTTER LAKESIDE MEDICAL PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 13, 1994
Last certification
Jul 21, 2014
Ownership / control type
2B
Most recent change of ownership
Jan 1, 2010 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1885 in CA
Enrollment address
987 Parallel Dr
Ste C
Lakeport, CA 95453-5702
Related CCNs
051329

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

Other NPIs with the same Medicare PAC ID 22

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

View all 22

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
05D0945313Sutter Lakeside Medical Practice987 Parallel Drive Ste C, Lakeport, CA 95453Provider-performed microscopyApr 26, 2027

National Provider Directory

National Provider Directory

Locations

5196 Hill Rd E
Ste 300
Lakeport, CA 95453
Phone (707) 263-6885

987 Parallel Dr
Lakeport, CA 95453
Phone (707) 262-5088

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
Yvonne Richardson Individual Corporate DirectorBoard Member Aug 4, 2021
Todd C Smith Individual Corporate DirectorBoard Member Jun 12, 2023
Gregory Brown Individual Corporate DirectorBoard Member Jan 1, 2025
Jill M Kacher Cobb Individual Corporate DirectorBoard Member Jan 1, 2019
Arnold Schaffer Individual Corporate DirectorBoard Member Jan 1, 2024
Theodore Deikel Individual Corporate DirectorBoard Member Jan 1, 2010
Janet Garufis Individual Corporate DirectorBoard Member Jan 1, 2024
Rita Ophelia Kwan-Feinberg Individual Corporate DirectorBoard Member Jan 1, 2025
Susan McCabe Individual Corporate OfficerSenior Director Jul 14, 2025
Juli Maxworthy Individual Corporate DirectorBoard Member Aug 4, 2021
Henry Yu Individual Corporate Officer Jun 9, 2023
W-2 Managing Employee Jun 9, 2023
Heidi J Schmidt Individual Corporate DirectorBoard Member Jan 1, 2025
Thomas Briody Individual Corporate DirectorBoard Member Feb 8, 2023
William L Brunetti Individual Corporate DirectorBoard Member Feb 8, 2023
Jeffrey T Strawn Individual Corporate DirectorBoard Member Jan 1, 2025
Yumi Nakagawa Individual Corporate DirectorBoard Member Jan 1, 2021
Sutter Health Organization, Sacramento, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2010 100%
Aditi H Patel Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Sutter Lakeside HospitalLakeport, CA, CCN 051329 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2010
California Pacific Medical Center - Davies CampusSan Francisco, CA, CCN 056245 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 59

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

View all 59

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1770816829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742412",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900742412",
            "telephone_number": "415-600-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5176 HILL RD E",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954536300",
            "telephone_number": "707-262-5000",
            "fax_number": "707-262-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUTTER BAY HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "GATES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "510-450-7357"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "110000094",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RKY13994F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sutter West Bay Hospitals",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Sutter West Bay Hospitals",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lakeport, CA

Sources for this page

Verify at the official NPI Registry.