NPIMap

Organization Active NPI

County of Humboldt

  • State or Local Public Health Clinic/Center
  • Eureka, CA
National Provider Identifier
1871676213
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
COUNTY OF HUMBOLDT
Practice address
529 I Street
Eureka, CA 95501-1116
Phone
(707) 445-6200
Fax
(707) 445-6097
NPI assigned
Oct 21, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Alexandra Wineland
Title
Public Health Branch Director
Phone
(707) 268-2121

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X Primary

Addresses

Primary practice location

529 I Street
Eureka, CA 95501-1116

Mailing address

529 I Street
Eureka, CA 95501-1116
Phone (707) 445-6200

Other identifiers 1

IdentifierTypeStateIssuer
CMM70414FMedicaidCA

Other names 1

  • Dept of Health & Human Services Public Health Branch Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040121001146 CA Part B Supplier - Clinic/Group Practice 4082516950 Receives reassigned benefits from 63 practitioners
1 other NPI on this enrollment
Practice locations: Willow Creek, CA; Eureka, CA

Other NPIs with the same Medicare PAC ID 1

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

  • County of Humboldt

    dba Humboldt County Behavioral Health - Sempervirens

    • Psychiatric Hospital Unit
    • Eureka, CA
    • NPI 1194763219

    4082516950

    Same PAC ID

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

Locations

529 I St
Eureka, CA 95501
Phone (707) 268-2105

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Humboldt County Mental Health - SempervirensEureka, CA, CCN 054124 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 31, 1988

Owned or controlled facilities with NPI records 1

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

  • County of Humboldt

    dba Humboldt County Behavioral Health - Sempervirens

    • Psychiatric Hospital Unit
    • Eureka, CA
    • NPI 1194763219

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871676213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 I STREET",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955011116",
            "telephone_number": "707-445-6200",
            "fax_number": "707-445-6097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 I STREET",
            "city": "EUREKA",
            "state": "CA",
            "postal_code": "955011116",
            "telephone_number": "707-445-6200",
            "fax_number": "707-445-6097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF HUMBOLDT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WINELAND",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_title_or_position": "PUBLIC HEALTH BRANCH DIRECTOR",
        "authorized_official_telephone_number": "707-268-2121"
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70414F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dept of Health & Human Services Public Health Branch Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eureka, CA

Sources for this page

Verify at the official NPI Registry.