NPIMap

Organization Active NPI

St. Joseph Health Northern California, LLC

Doing business as Providence Santa Rosa Memorial Hospital

  • Rehabilitation Hospital Unit
  • Santa Rosa, CA
National Provider Identifier
1881814903
Registry record updated May 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
Doing business as
Providence Santa Rosa Memorial Hospital
Practice address
1165 Montgomery Dr
Santa Rosa, CA 95405
Phone
(707) 525-5300
Fax
(707) 525-5392
NPI assigned
Apr 30, 2007
Last updated
May 8, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. JOSEPH HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 8, 2025

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X NU Primary

Addresses

Primary practice location

1165 Montgomery Dr
Santa Rosa, CA 95405

Mailing address

PO Box 31001-3059
Pasadena, CA 91110-3059
Phone (707) 522-4343

Other names 1

  • Providence Santa Rosa Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180402002216 CA Part A Provider - Hospital 8921374562 1 other NPI on this enrollment
Practice locations: Santa Rosa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881814903. Details of each certification follow.

Hospital certification: CCN 05T174

Legal name
ST JOSEPH HEALTH NORTHERN CALIFORNIA LLC
Doing business as
PROVIDENCE SANTA ROSA MEMORIAL HOSPITAL
Organization structure
LLCNon-profit
Incorporated
Oct 27, 2016 in CA
Enrollment address
1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Hospital Rehabilitation Unit
Hospital subgroups
General, Acute care, Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Santa Rosa Memorial HospitalCCN 05T174 · All quality measures
Ownership
Non-profit
Certified
Feb 1, 2000

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Health Northern California LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

1450 Medical Center Dr
Ste 3
Rohnert Park, CA 94928
Phone (707) 547-4652

2455 Bennett Valley Rd
Ste C216
Santa Rosa, CA 95404
Phone (707) 526-2273

3033 Cleveland Ave
Ste 220
Santa Rosa, CA 95403
Phone (707) 573-3550

500 Doyle Park Dr
Santa Rosa, CA 95405
Phone (707) 303-1719

525 Doyle Park Dr
Santa Rosa, CA 95405
Phone (707) 543-4600

920 Link Ln
Santa Rosa, CA 95401
Phone (707) 547-4612

925 Corporate Cntr Pkwy
Santa Rosa, CA 95407
Phone (707) 543-2000

925 Corporate Cntr Pkwy
Ste A
Santa Rosa, CA 95407
Phone (707) 543-2000

968 Gravenstein Ave
Sebastopol, CA 95472
Phone (707) 824-8018

17790 Greger St
Sonoma, CA 95476
Phone (707) 547-4612

251 Windsor River Rd
Windsor, CA 95492
Phone (707) 547-4612

Ownership & related parties

All disclosed owners & managing parties 18

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 DirectorBoard Member Jan 1, 2018
Oluyemi Adeyanju Individual Corporate OfficerSecretary Apr 1, 2018
Judith L Coffey Individual Corporate DirectorBoard Member May 26, 2021
Mary Bernadette McNulty Individual Corporate DirectorBoard Member Apr 1, 2018
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Apr 1, 2018
John Aryanpur Individual Corporate DirectorBoard Member Jan 1, 2020
Shelby D Arveson Individual Corporate OfficerCfo May 30, 2024
Conrad Hewitt Individual Corporate DirectorBoard Member Apr 1, 2018
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Apr 1, 2018
Keith Flamer Individual Corporate DirectorMember, Board of Managers Nov 28, 2023
Gregory David Hoffman Individual Corporate OfficerPresident/Ceo & Treasurer Oct 1, 2020
Jed Weissberg Individual Corporate DirectorBoard Member May 26, 2021
St. Joseph Health System Organization, Irvine, CA Corporation, Non-profit Other Apr 1, 2018
Laureen T Driscoll Individual Corporate OfficerChief Executive Jan 25, 2022
Erika K Wright Individual W-2 Managing EmployeeDelegated Official Feb 1, 2021
Pamela a Kindig Individual Corporate DirectorBoard Member Jan 1, 2020
St Joseph Health Northern California LLC Organization, Irvine, CA LLC, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2018 100%
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Apr 1, 2018

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 15

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

FacilityTypeRoleSince
Providence Redwood Memorial HospitalFortuna, CA, CCN 051318 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Providence Queen of the Valley Medical CenterNapa, CA, CCN 050009 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Providence St. Joseph HospitalEureka, CA, CCN 050006 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2011
Providence Redwood Memorial HospitalFortuna, CA, CCN 05Z318 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Providence Queen of the Valley Medical CenterNapa, CA, CCN 05T009 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Providence Santa Rosa Memorial HospitalSanta Rosa, CA, CCN 050174 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Petaluma Valley HospitalPetaluma, CA, CCN 050136 Hospital Operational/Managerial Control Jan 1, 2021
Healdsburg HospitalHealdsburg, CA, CCN 05Z321 Hospital Operational/Managerial Control Jan 1, 2021
Healdsburg HospitalHealdsburg, CA, CCN 051321 Hospital Operational/Managerial Control Jan 1, 2021
Healdsburg HospitalHealdsburg, CA, CCN 555590 Skilled nursing facility Operational/Managerial Control Jan 1, 2021
Providence Home Health SonomaSanta Rosa, CA, CCN 557433 Home health agency Other Apr 1, 2018
Providence Home Health HumboldtEureka, CA, CCN 057256 Home health agency Operational/Managerial Control Apr 1, 2018
Providence Hospice Napa ValleyNapa, CA, CCN 051537 Hospice Other Jun 1, 2020
Providence Hospice Sonoma CountyPetaluma, CA, CCN 051557 Hospice 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018
Providence Family PracticeFortuna, CA, CCN 058698 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2018

Owned or controlled facilities with NPI records 21

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

View all 21

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 8

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.

Affiliated clinicians 7

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

NPI Registry JSON

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

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746662400000",
    "number": "1881814903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-3059",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911103059",
            "telephone_number": "707-522-4343",
            "fax_number": "707-525-5392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 MONTGOMERY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "95405",
            "telephone_number": "707-525-5300",
            "fax_number": "707-525-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. JOSEPH HEALTH SYSTEM",
        "enumeration_date": "2007-04-30",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Santa Rosa Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.