NPIMap

Organization Active NPI

Coalinga Medical Center, LLC

Doing business as Coalinga Regional Medical Center

  • General Acute Care Hospital
  • Coalinga, CA
National Provider Identifier
1801452941
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
COALINGA MEDICAL CENTER, LLC
Doing business as
Coalinga Regional Medical Center
Coalinga Regional Medical Center, LLC
Practice address
1191 Phelps Ave
Coalinga, CA 93210-9609
Phone
(559) 935-6400
NPI assigned
May 14, 2019
Last updated
Jan 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Authorized official

Name
Tammy Jean Thompson
Title
Executive VP/Cfo
Phone
(209) 287-6308

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU
General Acute Care Hospital 282N00000X NU Primary
Critical Access Hospital 282NC0060X NU
Skilled Nursing Facility 314000000X NU

Addresses

Primary practice location

1191 Phelps Ave
Coalinga, CA 93210-9609

Mailing address

700 17TH St Ste 205
Modesto, CA 95354-1249
Phone (209) 287-6308

Other identifiers 3

IdentifierTypeStateIssuer
HSP40397FMedicaidCA
LTC55539FMedicaidCA
ZZR00397FMedicaidCA

Other names 2

  • Coalinga Regional Medical Center Doing business as
  • Coalinga Regional Medical Center, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20200414003883 CA Part A Provider - Skilled Nursing Facility 9133559214 Practice locations: Coalinga, CA
O20220107002031 CA Part A Provider - Rural Health Clinic 9133559214 Practice locations: Coalinga, CA
O20220225000864 CA Part A Provider - Critical Access Hospital 9133559214 Practice locations: Coalinga, CA
O20220413001817 CA Part A Provider - Critical Access Hospital 9133559214 Practice locations: Coalinga, CA

NPI to CCN mapping 5

The Medicare certification numbers (CCNs) connected to NPI 1801452941. Details of each certification follow.

Skilled nursing facility certification: CCN 555925

Legal name
COALINGA MEDICAL CENTER LLC
Doing business as
COALINGA REGIONAL MEDICAL CENTER
Certification status
Terminated Voluntary: merger or closure, Mar 28, 2024
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Jun 1, 2022
Last certification
Oct 13, 2021
Beds
51
Ownership / control type
Individual
Organization structure
LLCProprietary
Incorporated
Aug 8, 2018 in CA
Enrollment address
1191 Phelps Ave
Coalinga, CA 93210-9609

Rural health clinic certification: CCN 058654

Legal name
COALINGA MEDICAL CENTER LLC
Doing business as
COALINGA REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 7, 2010
Last certification
Feb 10, 2022
Ownership / control type
1A
Organization structure
LLCProprietary
Incorporated
Aug 8, 2018 in CA
Enrollment address
1165 Phelps Ave
Ste 105
Coalinga, CA 93210-9665
Related CCNs
050397

Hospital certification: CCN 051338

Legal name
COALINGA MEDICAL CENTER LLC
Doing business as
COALINGA REGIONAL MEDICAL CENTER LLC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 12, 2021
Last certification
Apr 12, 2021
Beds
138
Ownership / control type
Hospital district or authority
Organization structure
LLCProprietary
Incorporated
Aug 8, 2018 in CA
Enrollment address
1191 Phelps Ave
Coalinga, CA 93210-9609
Main/Primary Hospital Location

Hospital certification: CCN 05Z338

Legal name
COALINGA MEDICAL CENTER LLC
Doing business as
COALINGA REGIONAL MEDICAL CENTER LLC
Organization structure
LLCProprietary
Incorporated
Aug 8, 2018 in CA
Enrollment address
1191 Phelps Ave
Coalinga, CA 93210-9609
Hospital Swing-Bed Unit

Hospital certification: CCN 050397

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
COALINGA REGIONAL MEDICAL CENTER
Certification status
Terminated Other: provider status change, Apr 11, 2021
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 3, 2021
Beds
138
Ownership / control type
Hospital district or authority
Facility address
1191 Phelps Avenue
Coalinga, CA 93210

Care Compare: Hospital

Medicare Care Compare
Listed as
Coalinga Regional Medical CenterCCN 051338 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
05D2250777Coalinga Medical Center Rural Health Clinics1165 Phelps Ave Suite 105, Coalinga, CA 93210Certificate of waiverJan 27, 2028

National Provider Directory

National Provider Directory

Locations

1165 Phelps Ave
Ste 105
Coalinga, CA 93210
Phone (209) 287-6308

Ownership & related parties

All disclosed owners & managing parties 4

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 InterestOwner/Member Aug 8, 2018 100%
Operational/Managerial ControlOwner/Member Aug 8, 2018 100%
5% Or Greater Direct Ownership InterestOwner-Member Aug 8, 2018 100%
Operational/Managerial ControlOwner-Member Aug 8, 2018 100%
Tammy Thompson Individual Corporate OfficerChief Financial Officer Aug 8, 2018
Corporate DirectorChief Financial Officer Aug 8, 2018
Operational/Managerial ControlChief Financial Officer Aug 8, 2018
Contracted Managing EmployeeChief Financial Officer Aug 8, 2018
Amardeep Brar Individual Corporate OfficerAdministrator Jun 12, 2020
W-2 Managing EmployeeAdministrator Jun 12, 2020
Operational/Managerial ControlAdministrator Jun 12, 2020
Corporate OfficerChief Executive Officer Jun 12, 2020
Shamsher Bhullar Individual Other Aug 8, 2018

Owners & managing parties with NPI records 1

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

  • Gurpreet Singh, MD
    • Gastroenterology Physician
    • Turlock, CA
    • NPI 1194780999

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

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 23

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1801452941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 17TH ST STE 205",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953541249",
            "telephone_number": "209-287-6308",
            "fax_number": "209-248-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1191 PHELPS AVE",
            "city": "COALINGA",
            "state": "CA",
            "postal_code": "932109609",
            "telephone_number": "559-935-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COALINGA MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-14",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "EXECUTIVE VP/CFO",
        "authorized_official_telephone_number": "209-287-6308"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40397F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC55539F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR00397F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coalinga Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coalinga Regional Medical Center, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coalinga, CA

Sources for this page

Verify at the official NPI Registry.