NPIMap

Organization Active NPI

Shasta Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
National Provider Identifier
1891710638
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHASTA COMMUNITY HEALTH CENTER
Practice address
1035 Placer St
Redding, CA 96001-1170
Phone
(530) 246-5710
Fax
(530) 241-7838
NPI assigned
Jul 13, 2006
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Mr. Jeffery Brandon Thornock
Title
Ceo
Phone
(530) 246-5074

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Medical Physician Assistant 363AM0700X 230000171 CA
Family Nurse Practitioner 363LF0000X 230000171 CA
Clinical Neuropsychologist 103G00000X 230000171 CA
Clinical Social Worker 1041C0700X 230000171 CA
Pediatric Dermatology Physician 207NP0225X 230000171 CA
Family Medicine Physician 207Q00000X 230000171 CA
Internal Medicine Physician 207R00000X 230000171 CA
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 230000171 CA
Infectious Disease Physician 207RI0200X 230000171 CA
Rheumatology Physician 207RR0500X 230000171 CA
Obstetrics & Gynecology Physician 207V00000X 230000171 CA
Pediatrics Physician 208000000X 230000171 CA
Pediatric Cardiology Physician 2080P0202X 230000171 CA
Diagnostic Ultrasound Physician 2085U0001X 230000171 CA

Addresses

Primary practice location

1035 Placer St
Redding, CA 96001-1170

Mailing address

PO Box 992790
Redding, CA 96099-2790
Phone (530) 246-5710

Other identifiers 1

IdentifierTypeStateIssuer
FHC70418FOtherCASCHC MEDI-CAL NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040629000721 CA Part B Supplier - Clinic/Group Practice 3870579816 Receives reassigned benefits from 156 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anderson, CA; Redding, CA; Shasta Lake, CA
O20071112000530 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870579816 Practice locations: Redding, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891710638. Details of each certification follow.

Federally qualified health center certification: CCN 051976

Legal name
SHASTA COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 25, 1995
Last certification
Sep 25, 1995
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 7, 1988 in CA
Enrollment address
1035 Placer St
Redding, CA 96001-1170

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Laura Baynard Individual Corporate OfficerChief Operations Officer Mar 3, 2024
W-2 Managing EmployeeChief Operations Officer Mar 3, 2024
Stephen Bell Individual Corporate Director Jan 26, 2024
Christy Coleman Individual Corporate DirectorCommunity Member Apr 27, 2023
Alicia Torge Individual Corporate OfficerProvider Member Sep 25, 2025
Daniel Santi Individual Corporate OfficerChief Financial Officer Aug 24, 2023
W-2 Managing EmployeeChief Financial Officer Aug 24, 2023
Michael Mangas Individual Corporate Director Jul 25, 2019
Robert Folden Individual Corporate Director Dec 31, 2021
Brian Bradley Individual Corporate OfficerCommunity Member Oct 17, 1973
Wendy Longwell Individual Corporate DirectorTreasurer Jun 25, 2014
Anastasiia Borysiuk Individual Corporate DirectorConsumer Member Apr 11, 1991
John Kenny Individual Corporate DirectorVice Chair Apr 22, 2013
Samantha Breton Individual Corporate DirectorConsumer Member Oct 27, 2022
Lawrence Vogt Individual Corporate OfficerConsumer Member Jun 27, 2024
Kerry Fasking Individual Corporate DirectorChair Jul 24, 2013
Brandon Thornock Individual Corporate OfficerCoo Oct 1, 1992
W-2 Managing Employee Oct 1, 2017
Margaret Beck Individual Corporate Director Feb 23, 2017
Dot Van Cleave Individual Corporate DirectorConsumer Member Sep 28, 2017

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1891710638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 992790",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960992790",
            "telephone_number": "530-246-5710",
            "fax_number": "530-241-7838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 PLACER ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011170",
            "telephone_number": "530-246-5710",
            "fax_number": "530-241-7838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASTA COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "THORNOCK",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "BRANDON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-246-5074",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "230000171",
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": "230000171",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SCHC MEDI-CAL NUMBER",
            "identifier": "FHC70418F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.