NPIMap

Organization Active NPI

Redding Rancheria

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
National Provider Identifier
1780423244
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
REDDING RANCHERIA
Practice address
3305 Placer Street Suite B
Redding, CA 96001
Phone
(530) 225-6805
Fax
(530) 262-6592
NPI assigned
May 23, 2024
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Tamra Dawn Olson
Title
Administrator
Phone
(530) 242-4523

Owners & managing parties with NPI records 4

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

Owned or controlled facilities with NPI records 2

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

  • Redding Rancheria
    • Federally Qualified Health Center (FQHC)
    • Redding, CA
    • NPI 1104859354

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Redding Rancheria
    • Federally Qualified Health Center (FQHC)
    • Weaverville, CA
    • NPI 1386164580

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 2

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

Facilities with the same owner 2

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

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 63

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
05D2308919Redding Rancheria Center for Advanced Care3305 Placer St Ste B, Redding, CA 96001Provider-performed microscopyAug 5, 2026

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040810001377 CA Part B Supplier - Clinic/Group Practice 7810969847 Receives reassigned benefits from 65 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Redding, CA; Weaverville, CA
O20240924003696 CA Part a Provider - Federally Qualified Health Center (FQHC) 7810969847 Practice locations: Redding, CA

Federally qualified health center certification: CCN A01879

Medicare enrollment files
Legal name
REDDING RANCHERIA
Doing business as
REDDING RANCHERIA CENTER FOR ADVANCED CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 11, 2024
Last certification
Sep 11, 2024
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Sep 7, 1996 in CA
Enrollment address
3305 Placer St
Ste B
Redding, CA 96001-2378

All disclosed owners & managing parties 6

Medicare enrollment files

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

NameRoleSinceShare
Glen Ruel Hayward Individual Corporate DirectorExecutive Director of Health Servic Aug 7, 2017 100%
Operational/Managerial ControlExec Director of Health Services Aug 7, 2017 100%
Redding Rancheria Organization, Redding, CA 5% Or Greater Direct Ownership Interest Aug 7, 2017 100%
Tracy L Edwards Individual Corporate OfficerChief Executive Officer Aug 7, 2017 100%
Operational/Managerial ControlAuthorized Official Aug 7, 2017 100%
Tamra Dawn Olson Individual Corporate OfficerChief Financial Officer Aug 7, 2017 100%
Paul R Davis Individual Corporate DirectorMedical Director Aug 7, 2017 100%
Stacey Carman Individual Corporate OfficerChief Operating Officer Oct 21, 1991 100%

All facility ownership & control disclosures 2

Medicare enrollment files

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

FacilityTypeRoleSince
Redding RancheriaRedding, CA, CCN 051901 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 21, 1998
Redding RancheriaWeaverville, CA, CCN 921010 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Aug 7, 2017
Aug 7, 2017

National Provider Directory

National Provider Directory
Tax ID family
Redding Rancheria4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

NPPES NPI Registry

Primary practice location

3305 Placer Street Suite B
Redding, CA 96001

Mailing address

1441 Liberty Street
Redding, CA 96001
Phone (530) 224-2700

Other names 1

NPPES NPI Registry
  • Redding Rancheria Center for Advanced Care Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 23, 2024.

{
    "created_epoch": "1716422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1780423244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 LIBERTY STREET",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "96001",
            "telephone_number": "530-224-2700",
            "fax_number": "530-224-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3305 PLACER STREET SUITE B",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "96001",
            "telephone_number": "530-225-6805",
            "fax_number": "530-262-6592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDDING RANCHERIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "TAMRA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "530-242-4523"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redding Rancheria Center for Advanced Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.