NPIMap

Organization Active NPI

West County Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Sebastopol, CA
National Provider Identifier
1861809501
Registry record updated Dec 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WEST COUNTY HEALTH CENTERS, INC.
Practice address
652 Petaluma Ave
Sebastopol, CA 95472-4256
Phone
(707) 869-5977
Fax
(707) 869-5976
NPI assigned
Jul 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2014

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

Authorized official

Name
Ms. Mary E Szecsey
Title
Executive Director
Phone
(707) 869-1594

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

652 Petaluma Ave
Sebastopol, CA 95472-4256

Mailing address

PO Box 1449
Guerneville, CA 95446-1449
Phone (707) 869-5977

Other names 1

  • Gravenstein Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140813001644 CA Part A Provider - Federally Qualified Health Center (FQHC) 6800782277 Practice locations: Sebastopol, CA

Federally qualified health center certification: CCN 751113

Legal name
WEST COUNTY HEALTH CENTERS, INC.
Doing business as
GRAVENSTEIN COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2014
Last certification
Aug 8, 2014
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jul 20, 1973 in CA
Enrollment address
652 Petaluma Ave
Ste H
Sebastopol, CA 95472-4266

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
West County Health Cent9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Howard John Kornfeld Individual Corporate DirectorBoard Member Jul 15, 2014
Jason Lee Cunningham Individual Corporate Officer Mar 5, 2020
Mary S Felton Individual Corporate DirectorBoard Member Jul 15, 2014
Robert W Heinemeier Individual Contracted Managing EmployeeChief Financial Officer Jun 1, 2020
Corporate OfficerChief Financial Officer Jun 1, 2020
Henry P Hamlin Individual Corporate DirectorBoard Member Jul 15, 2014
Dwight Cary Individual Corporate DirectorBoard Member Jul 15, 2014
Alan H Siegle Individual Corporate DirectorBoard Member Jul 15, 2014
Ila K Sheridan Individual Corporate DirectorBoard Member Jul 15, 2014
Debra Johnson Individual Corporate DirectorBoard Member Jul 15, 2014

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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1405382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1861809501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "GUERNEVILLE",
            "state": "CA",
            "postal_code": "954461449",
            "telephone_number": "707-869-5977",
            "fax_number": "707-869-5976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 PETALUMA AVE",
            "city": "SEBASTOPOL",
            "state": "CA",
            "postal_code": "954724256",
            "telephone_number": "707-869-5977",
            "fax_number": "707-869-5976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST COUNTY HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-15",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "SZECSEY",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "707-869-1594",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gravenstein Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sebastopol, CA

Sources for this page

Verify at the official NPI Registry.