NPIMap

Organization Active NPI

Winters Healthcare Foundation, Inc.

  • Family Medicine Physician
  • Esparto, CA
National Provider Identifier
1821709643
Registry record updated Mar 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 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
Last updated
Mar 25, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WINTERS HEALTHCARE FOUNDATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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

Authorized official

Name
Christopher Kelsch
Title
Executive Director
Phone
(530) 212-1039

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

17340 Yolo Ave
Esparto, CA 95627

Mailing address

172 E Grant Ave
Winters, CA 95694-1780
Phone (530) 212-1025

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821709643. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
17340 Yolo Ave
Esparto, CA 95627-2265

Other NPIs with the same Medicare PAC ID 1

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

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
Tax ID family
Winters Healthcare Foundation Inc3 organizations share this tax ID, including this one
Part of
Winters Healthcare Foundation Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

172 E Grant Ave
Winters, CA 95694
Phone (530) 212-1025

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Erik Brunkal Individual Corporate Director Apr 1, 2011
Robert a Schultz Individual Corporate Director Oct 7, 2019
Ramon M Altamirano Individual Corporate Director Jun 29, 2018
Monika T Brunkal Individual Corporate Director Oct 7, 2019
Lucila G Escamilla Individual Corporate Director Nov 14, 2017
Jennifer Jacobs Garcia Individual Corporate Director Dec 3, 2015
Christopher Kelsch Individual Corporate Director Jun 2, 2005
W-2 Managing EmployeeAd; Jun 2, 2005

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

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": "1670889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1821709643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "172 E GRANT AVE",
            "city": "WINTERS",
            "state": "CA",
            "postal_code": "956941780",
            "telephone_number": "530-212-1025",
            "fax_number": "530-230-2547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17340 YOLO AVE",
            "city": "ESPARTO",
            "state": "CA",
            "postal_code": "95627",
            "telephone_number": "530-795-4377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINTERS HEALTHCARE FOUNDATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WINTERS HEALTHCARE FOUNDATION, INC.",
        "enumeration_date": "2022-12-13",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "status": "A",
        "authorized_official_last_name": "KELSCH",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "530-212-1039"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Esparto, CA

Sources for this page

Verify at the official NPI Registry.