Winters Healthcare Foundation, Inc.
Organization Active NPI Family Medicine Physician · Esparto, CA
NPI 1821709643 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1821709643
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- WINTERS HEALTHCARE FOUNDATION, INC.
- Practice address
- 17340 Yolo Ave
Esparto, CA 95627 - Phone
- (530) 795-4377
- NPI assigned
- Dec 13, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- WINTERS HEALTHCARE FOUNDATION, INC.
Authorized official
- Name
- Christopher Kelsch
- Title
- Executive Director
- Phone
- (530) 212-1039
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 2
Practitioners 6
-
Virginia Anne Leone, MD, MPH
-
Jesus Javier Luna, PH.D.
-
Ashley Evans, NP
-
Jaime Lopez, P.A.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN A01893
- Legal name
- WINTERS HEALTHCARE FOUNDATION, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 12, 2024
- Last certification
- Sep 12, 2024
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 17340 Yolo Ave
Esparto, CA 95627-2265
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Erik Brunkal |
Corporate Director | Apr 1, 2011 | |
| Robert a Schultz |
Corporate Director | Oct 7, 2019 | |
| Ramon M Altamirano |
Corporate Director | Jun 29, 2018 | |
| Monika T Brunkal |
Corporate Director | Oct 7, 2019 | |
| Lucila G Escamilla |
Corporate Director | Nov 14, 2017 | |
| Jennifer Jacobs Garcia |
Corporate Director | Dec 3, 2015 | |
| Christopher Kelsch |
Corporate Director | Jun 2, 2005 | |
| W-2 Managing Employee |
Jun 2, 2005 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070426000372 | CA | Part B Supplier - Clinic/Group Practice | 2567490238 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Esparto, CA; Winters, CA |
| O20241206002792 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 2567490238 | Practice locations: Esparto, CA |
National Provider Directory
- Tax ID family
- Winters Healthcare Foundation Inc
- Part of
- Winters Healthcare Foundation Inc
Locations
23 Main St
Winters, CA 95694
Phone (530) 795-4377
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
17340 Yolo Ave
Esparto, CA 95627
Mailing address
172 E Grant Ave
Winters, CA 95694-1780
Phone (530) 212-1025
Other providers in Esparto, CA
- Nicole Sandoval
- Julia Seebach
- Adrian Gabriel Solis
- Meritsa Esperanza Soria
- Winters Healthcare Foundation, Inc.
- Yolo County Health and Human Services Agency
- Julie Zentner
All providers in Esparto, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.