NPIMap

Organization Active NPI

Colusa Indian Community Council

Doing business as Colusa Indian Health Clinic

  • 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
Doing business as
Colusa Indian Health Clinic
Practice address
3710 Highway 45
Colusa, CA 95932
Phone
(530) 458-5501
Fax
(530) 458-8660
NPI assigned
Aug 25, 2005
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
COLUSA INDIAN COMMUNITY COUNCILAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

3710 Highway 45
Colusa, CA 95932

Mailing address

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

Other names 2

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

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790778660. Details of each certification follow.

Federally qualified health center certification: CCN 551948

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

National Provider Directory

National Provider Directory
Part of
Colusa Indian Community Council

Locations

346 5th St
Colusa, CA 95932

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

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

Ownership & related parties

All disclosed owners & managing parties 2

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%

Practitioners & affiliated clinicians

Practitioners 12

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": "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.