NPIMap

Organization Active NPI

Sonora Community Hospital

Doing business as Angels Camp Family Medical Center

  • Family Medicine Physician
  • Angels Camp, CA
National Provider Identifier
1821089749
Registry record updated Mar 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SONORA COMMUNITY HOSPITAL
Doing business as
Angels Camp Family Medical Center
Practice address
445 South Main St
Angels Camp, CA 95222
Phone
(209) 736-0249
Fax
(209) 533-7696
NPI assigned
Oct 31, 2005
Last updated
Mar 29, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
SONORA COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 29, 2013

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

Authorized official

Name
Andrew D. Jahn
Title
Vice President for Finance
Phone
(209) 536-5011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

445 South Main St
Angels Camp, CA 95222

Mailing address

14542 Lolly LN
Sonora, CA 95370-9226
Phone (209) 536-2760

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ52950ZOtherCABLUE CROSS/BLUE SHIELD

Other names 1

  • Angels Camp Family Medical Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050411001282 CA Part B Supplier - Clinic/Group Practice 4284538505 Receives reassigned benefits from 7 practitioners
Practice locations: Angels Camp, CA
O20071214000277 CA Part A Provider - Hospital 4284538505 16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Angels Camp, CA; Sonora, CA; Groveland, CA; Arnold, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821089749. Details of each certification follow.

Hospital certification: CCN 050335

Legal name
SONORA COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 13, 2023
Beds
143 (75 certified)
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1958 in CA
Enrollment address
1000 Greenley Rd
Sonora, CA 95370-5200
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 11

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Adventist Health SonoraCCN 050335 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

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
05D0898994Sonora Community Hospital445 S Main St, Angels Camp, CA 95222Certificate of waiverOct 9, 2026

National Provider Directory

National Provider Directory
Part of
Sonora Community

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
Kerry L Heinrich Individual Corporate OfficerChairman of the Board Jan 1, 2022
Corporate DirectorChairman of the Board Dec 16, 2014
Velino a Salazar Individual Corporate DirectorBoard Member Sep 15, 2015
Meredith S Jobe Individual Corporate OfficerSecretary Mar 31, 2014
Richard K Reiner Individual Corporate DirectorBoard Member Jan 16, 2017
Joy a. Fehr Individual Corporate DirectorBoard Member Oct 1, 2020
Jonathan J Daggett Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew R Davis Individual Corporate DirectorBoard Member May 5, 2017
Todd N Hofheins Individual Corporate OfficerVice Chairman Jan 24, 2022
Ann K Beckett Individual Corporate DirectorBoard Member Jan 1, 2024
Marc K Woodson Individual Corporate DirectorBoard Member Jan 1, 2019
John C Freedman Individual Corporate DirectorBoard Member Sep 26, 2016
Gregory D McCulloch Individual Corporate OfficerPresident May 29, 2024
W-2 Managing EmployeePresident May 5, 2014
Jack W Wagner Individual Corporate DirectorBoard Member Dec 1, 2022
Kenneth Jutzy Individual Corporate DirectorBoard Member Jan 1, 2024
Bradford C Newton Individual Corporate DirectorBoard Member Aug 16, 2021
Robert a Cherry Individual Corporate OfficerBoard Member May 5, 2017
Larry L Innocent Individual Corporate DirectorBoard Member Jun 1, 2015
Adventist Health System/West Organization, Roseville, CA Corporation, Non-profit Operational/Managerial Control Jun 16, 1980 100%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

Affiliated clinicians 493

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

View all 493

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1821089749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14542 LOLLY LN",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953709226",
            "telephone_number": "209-536-2760",
            "fax_number": "209-533-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 SOUTH MAIN ST",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "95222",
            "telephone_number": "209-736-0249",
            "fax_number": "209-533-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONORA COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SONORA COMMUNITY HOSPITAL",
        "enumeration_date": "2005-10-31",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "JAHN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "VICE PRESIDENT FOR FINANCE",
        "authorized_official_telephone_number": "209-536-5011"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "ZZZ52950Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angels Camp Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Angels Camp, CA

Sources for this page

Verify at the official NPI Registry.