NPIMap

Organization Active NPI

Norcal Healthconnect LLC

Doing business as Healdsburg Hospital

  • Critical Access Hospital
  • Healdsburg, CA
National Provider Identifier
1861009672
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
NORCAL HEALTHCONNECT LLC
Doing business as
Healdsburg Hospital
Practice address
1375 University Ave
Healdsburg, CA 95448-3382
Phone
(707) 431-6500
NPI assigned
Sep 25, 2020
Last updated
May 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU
Critical Access Hospital 282NC0060X NU Primary

Addresses

Primary practice location

1375 University Ave
Healdsburg, CA 95448-3382

Mailing address

PO Box 31001-3085
Pasadena, CA 91110-3085
Phone (707) 431-6500

Other names 1

  • HEALDSBURG HOSPITAL Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201225000001 CA Part A Provider - Critical Access Hospital 2466864038 Receives reassigned benefits from 29 practitioners
1 other NPI on this enrollment
Practice locations: Healdsburg, CA
O20210308001127 CA Part B Supplier - Clinic/Group Practice 2466864038 Receives reassigned benefits from 34 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Healdsburg, CA; Petaluma, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861009672. Details of each certification follow.

Hospital certification: CCN 051321

Legal name
NORCAL HEALTHCONNECT LLC
Doing business as
HEALDSBURG HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 1, 2005
Last certification
Oct 2, 2025
Beds
26
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jan 1, 2021 (1 total)
Organization structure
LLCNon-profit
Enrollment address
1375 University Ave
Healdsburg, CA 95448-3382
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Healdsburg HospitalCCN 051321 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Norcal Healthconnect LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
James C Devore Individual Corporate DirectorMember, Board of Managers Jan 1, 2021
Oluyemi Adeyanju Individual Corporate OfficerCorporate Secretary Jan 1, 2021
Judith L Coffey Individual Corporate DirectorMember, Board of Managers May 26, 2021
Troy a Gideon Individual W-2 Managing EmployeeAd; Oct 20, 2023
Mary Bernadette McNulty Individual Corporate DirectorMember, Board of Managers Jan 1, 2021
Norcal Healthconnect LLC Organization, Santa Rosa, CA Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jan 1, 2021 100%
Providence Health & Services - Washington Organization, Renton, WA Corporation Operational/Managerial Control Jan 1, 2021
John Aryanpur Individual Corporate DirectorMember, Board of Managers Jan 1, 2021
Western Healthconnect Organization, Renton, WA Corporation Other Jan 1, 2021
Conrad Hewitt Individual Corporate DirectorMember, Board of Managers Jan 1, 2021
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary for Enrollme Jan 1, 2021
Keith Flamer Individual Corporate DirectorMember, Board of Managers Nov 28, 2023
Gregory David Hoffman Individual Corporate OfficerChief Executive/President Jan 21, 2021
Nathan Reinert Husmann Individual Corporate OfficerTreasurer Apr 28, 2023
Jed Weissberg Individual Corporate DirectorMember, Board of Managers May 26, 2021
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Operational/Managerial Control Jan 1, 2021
Laureen T Driscoll Individual Corporate OfficerRegional Ceo Jan 25, 2022
Bharatha B Naotunne Individual W-2 Managing EmployeeFinancial Executive Oct 17, 2022
Pamela a Kindig Individual Corporate DirectorMember, Board of Managers Jan 1, 2020
St Joseph Health Northern California LLC Organization, Irvine, CA LLC, Non-profit Operational/Managerial Control Jan 1, 2021

Owners & managing parties with NPI records 15

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

View all 15

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Petaluma Valley HospitalPetaluma, CA, CCN 050136 Hospital 5% Or Greater Direct Ownership Interest Jan 1, 2021
Healdsburg HospitalHealdsburg, CA, CCN 05Z321 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2021
Healdsburg HospitalHealdsburg, CA, CCN 555590 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2021

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 139

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 139

Practitioners & affiliated clinicians

Practitioners 30

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 30

Affiliated clinicians 214

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

View all 214

NPI Registry JSON

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

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747094400000",
    "number": "1861009672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-3085",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911103085",
            "telephone_number": "707-431-6500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1375 UNIVERSITY AVE",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954483382",
            "telephone_number": "707-431-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORCAL HEALTHCONNECT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-25",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HEALDSBURG HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HEALDSBURG HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Healdsburg, CA

Sources for this page

Verify at the official NPI Registry.