NPIMap

Organization Active NPI

Oak Valley Hospital District

Doing business as Waterford Community Health Center

  • Rural Health Clinic/Center
  • Waterford, CA
National Provider Identifier
1881030401
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
030000069 Issued in CA
Legal business name
OAK VALLEY HOSPITAL DISTRICT
Doing business as
Waterford Community Health Center
Practice address
12146 Yosemite Blvd
Waterford, CA 95386-9163
Phone
(209) 848-4138
Fax
(209) 848-7008
NPI assigned
May 22, 2013
Last updated
Dec 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
OAK VALLEY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Authorized official

Name
Ann Croskrey
Title
Chief Financial Officer
Phone
(209) 848-4104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 030000069 CA Primary

Addresses

Primary practice location

12146 Yosemite Blvd
Waterford, CA 95386-9163

Mailing address

350 S Oak Ave
Oakdale, CA 95361-3519
Phone (209) 848-3011

Other names 1

  • WATERFORD 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
O20140110001182 CA Part A Provider - Rural Health Clinic 5496736613 Practice locations: Waterford, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881030401. Details of each certification follow.

Rural health clinic certification: CCN 058679

Legal name
OAK VALLEY HOSPITAL DISTRICT
Doing business as
WATERFORD COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 30, 2015
Last certification
Nov 28, 2023
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Incorporated
Jan 1, 2014 in CA
Enrollment address
12146 Yosemite Blvd
Waterford, CA 95386-9163
Related CCNs
050067

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

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Oak Valley Port X Ray S9 organizations share this tax ID, including this one
Part of
Oak Valley Port X Ray S

Other organizations with this tax ID 8

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

Locations

12146 Yosemite Blvd
Waterford, CA 95386
Phone (209) 848-4138

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
Danielle Sanders Individual Corporate DirectorBoard Member Apr 3, 2025
Matthew M Heyn Individual W-2 Managing EmployeeAd; Aug 7, 2023 100%
Jennifer Cook Individual W-2 Managing EmployeeDirector of Quality, Risk MGMT Apr 21, 2022
Oak Valley Hospital District Organization, Oakdale, CA Operational/Managerial Control Mar 23, 2023 100%
Daniel Cummins Individual Corporate DirectorChair Nov 15, 2010
Edward Chock Individual Corporate DirectorSecretary Nov 15, 2010
Sara Shipman Individual Corporate DirectorBoard Member Jan 9, 2025

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Oak Valley District HospitalOakdale, CA, CCN 050067 Hospital Operational/Managerial Control (100%) Jun 18, 1968
Oakdale Nursing & Rehabilitation CenterOakdale, CA, CCN 056155 Skilled nursing facility Operational/Managerial Control Nov 1, 2011
Escalon Community Health ClinicEscalon, CA, CCN 058606 Rural health clinic Operational/Managerial Control (100%) Jun 18, 1968
Riverbank Community Health CenterRiverbank, CA, CCN 058528 Rural health clinic Operational/Managerial Control (100%) Jun 18, 1968
Oakdale Community Health CenterOakdale, CA, CCN 553978 Rural health clinic Operational/Managerial Control (100%) Jun 18, 1968

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

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

NPI Registry JSON

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608249600000",
    "number": "1881030401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 S OAK AVE",
            "city": "OAKDALE",
            "state": "CA",
            "postal_code": "953613519",
            "telephone_number": "209-848-3011",
            "fax_number": "209-848-7008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12146 YOSEMITE BLVD",
            "city": "WATERFORD",
            "state": "CA",
            "postal_code": "953869163",
            "telephone_number": "209-848-4138",
            "fax_number": "209-848-7008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAK VALLEY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OAK VALLEY HOSPITAL DISTRICT",
        "enumeration_date": "2013-05-22",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A",
        "authorized_official_last_name": "CROSKREY",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "209-848-4104"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "030000069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WATERFORD COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WATERFORD COMMUNITY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waterford, CA

Sources for this page

Verify at the official NPI Registry.