NPIMap

Organization Active NPI

Plumas District Hospital

  • Rural Health Clinic/Center
  • Greenville, CA
National Provider Identifier
1881068708
Registry record updated Oct 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
230000030 Issued in CA
Legal business name
PLUMAS DISTRICT HOSPITAL
Practice address
176 Hot Springs Rd
Greenville, CA 95947-9747
Phone
(530) 284-6116
Fax
(530) 284-6926
NPI assigned
Nov 16, 2015
Last updated
Oct 7, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PLUMAS DISTRICT HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 7, 2022

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

Authorized official

Name
Jeffrey Kepple, M.D.NPI 1467428516
Title
Ceo
Phone
(530) 283-7127

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 230000030 CA Primary

Addresses

Primary practice location

176 Hot Springs Rd
Greenville, CA 95947-9747

Mailing address

176 Hot Springs Rd
Greenville, CA 95947-9747
Phone (530) 284-6116

Other names 1

  • Indian Valley Medical Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160119000262 CA Part A Provider - Rural Health Clinic 8224930466 Practice locations: Greenville, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881068708. Details of each certification follow.

Rural health clinic certification: CCN 058636

Legal name
PLUMAS DISTRICT HOSPITAL
Doing business as
INDIAN VALLEY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 4, 2007
Last certification
Mar 20, 2019
Ownership / control type
Non-profit – church related
Most recent change of ownership
Feb 1, 2016 (1 total)
Organization structure
OtherNon-profit
Enrollment address
176 Hot Springs Rd
Greenville, CA 95947-9747
Related CCNs
051326

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Plumas Dist HSP Pulmona6 organizations share this tax ID, including this one
Part of
Plumas Dist HSP Pulmona

Other organizations with this tax ID 5

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

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
Bill H Wickman Individual Corporate DirectorPresident Jan 2, 2010
Caleb Johnson Individual Corporate OfficerChief Financial Officer Jul 6, 2015
Lisette M Brown Individual Corporate OfficerChief Clinical Officer Jun 3, 2015
Karen Story Individual W-2 Managing EmployeeMedical Staff Coordinator Jan 1, 1996
Valerie R Flanigan Individual Corporate DirectorBoard Member Mar 9, 2006
John a Kimmel Individual Corporate DirectorDirector Jan 1, 1998
Plumas District Hospital Organization, Quincy, CA Other Jan 1, 1966

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Plumas District HospitalQuincy, CA, CCN 051326 Hospital Other Jan 1, 1995
Plumas District HospitalQuincy, CA, CCN 05Z326 Hospital Operational/Managerial Control Jan 1, 1966
Plumas Rural Health CenterQuincy, CA, CCN 053989 Rural health clinic Other Jan 1, 1995

Owned or controlled facilities with NPI records 3

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

Change-of-ownership history 1

DateEventCounterparty
Feb 1, 2016 Change of OwnershipThis provider was the buyer Indian Valley Medical ClinicCCN 058636, CA, NPI 1316143043

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1447632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665100800000",
    "number": "1881068708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "176 HOT SPRINGS RD",
            "city": "GREENVILLE",
            "state": "CA",
            "postal_code": "959479747",
            "telephone_number": "530-284-6116",
            "fax_number": "530-284-6926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 HOT SPRINGS RD",
            "city": "GREENVILLE",
            "state": "CA",
            "postal_code": "959479747",
            "telephone_number": "530-284-6116",
            "fax_number": "530-284-6926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLUMAS DISTRICT HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PLUMAS DISTRICT HOSPITAL",
        "enumeration_date": "2015-11-16",
        "last_updated": "2022-10-07",
        "certification_date": "2022-10-07",
        "status": "A",
        "authorized_official_last_name": "KEPPLE",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-283-7127",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "230000030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Valley Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenville, CA

Sources for this page

Verify at the official NPI Registry.