NPIMap

Organization Active NPI

Colusa Indian Community Council

  • Federally Qualified Health Center (FQHC)
  • Colusa, CA
National Provider Identifier
1790778660
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLUSA INDIAN COMMUNITY COUNCIL
Practice address
3710 Highway 45
Colusa, CA 95932
Phone
(530) 458-5501
Fax
(530) 458-8660
NPI assigned
Aug 25, 2005
Organization subpart
Yes
Parent organization
COLUSA INDIAN COMMUNITY COUNCILAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Catrina Marie Ross
Title
Director of Clinic Operations
Phone
(530) 458-6542

Practitioners 12

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101220000276 CA Part a Provider - Federally Qualified Health Center (FQHC) 1951211069 Practice locations: Colusa, CA

Federally qualified health center certification: CCN 551948

Medicare enrollment files
Legal name
COLUSA INDIAN COMMUNITY COUNCIL
Doing business as
COLUSA INDIAN HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 2004
Last certification
Feb 5, 2004
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
3710 State Highway 45 a
Colusa, CA 95932-4026

All disclosed owners & managing parties 2

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
Colusa Indian Community Council Organization, Colusa, CA 5% Or Greater Direct Ownership Interest Oct 22, 2010 100%
Catrina M Ross Individual Corporate DirectorDirector of Clinic Operations Oct 1, 2017 100%
W-2 Managing EmployeeDirector of Clinic Operations Sep 27, 2017 100%

National Provider Directory

National Provider Directory
Part of
Colusa Indian Health CL

Locations

3710 State Highway 45
Ste A
Colusa, CA 95932
Phone (530) 458-5501

3720 Highway 45
Colusa, CA 95932
Phone (530) 458-0295

346 5th St
Colusa, CA 95932

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

3710 Highway 45
Colusa, CA 95932

Mailing address

3710 Highway 45
Colusa, CA 95932
Phone (530) 458-5501

Other names 2

NPPES NPI Registry
  • Colusa Indian Health Clinic Doing business as
  • Colusa Indian Community Council Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 16, 2018.

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1790778660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3710 HIGHWAY 45",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "95932",
            "telephone_number": "530-458-5501",
            "fax_number": "530-458-8660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 HIGHWAY 45",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "95932",
            "telephone_number": "530-458-5501",
            "fax_number": "530-458-8660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUSA INDIAN COMMUNITY COUNCIL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUSA INDIAN COMMUNITY COUNCIL",
        "enumeration_date": "2005-08-25",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ROSS",
        "authorized_official_first_name": "CATRINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "DIRECTOR OF CLINIC OPERATIONS",
        "authorized_official_telephone_number": "530-458-6542"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colusa Indian Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colusa Indian Community Council",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Colusa Indian Community Council",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Colusa, CA

Sources for this page

Verify at the official NPI Registry.