NPIMap

Organization Active NPI

Southern Mono Health Care District

  • Rural Acute Care Hospital
  • Bridgeport, CA
National Provider Identifier
1821149816
Registry record updated Mar 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
240000008 Issued in CA
Legal business name
SOUTHERN MONO HEALTH CARE DISTRICT
Practice address
221 Twin Lakes Road
Bridgeport, CA 93517
Phone
(760) 932-7011
Fax
(760) 932-7180
NPI assigned
Jan 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2013

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

Authorized official

Name
Mrs. Melanie Van Winkle
Title
Chief Financial Offi
Phone
(760) 934-3311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 240000008 CA Primary

Addresses

Primary practice location

221 Twin Lakes Road
Bridgeport, CA 93517

Mailing address

PO Box 660
Mammoth Lakes, CA 93546-0660
Phone (760) 934-3311

Other names 1

  • Bridgeport Family Medicine Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118001160 CA Part B Supplier - Clinic/Group Practice 9830002401 Receives reassigned benefits from 122 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mammoth Lakes, CA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1821149816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660",
            "city": "MAMMOTH LAKES",
            "state": "CA",
            "postal_code": "935460660",
            "telephone_number": "760-934-3311",
            "fax_number": "760-924-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 TWIN LAKES ROAD",
            "city": "BRIDGEPORT",
            "state": "CA",
            "postal_code": "93517",
            "telephone_number": "760-932-7011",
            "fax_number": "760-932-7180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN MONO HEALTH CARE DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "VAN WINKLE",
        "authorized_official_first_name": "MELANIE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFI",
        "authorized_official_telephone_number": "760-934-3311",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "CA",
            "license": "240000008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridgeport Family Medicine Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgeport, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.