Pit River Health Service, Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

230000179 Issued in CA

Legal business name

PIT RIVER HEALTH SERVICE, INC.

Practice address

36977 Park Ave
Burney, CA 96013

Phone

(530) 335-5090

Fax

(530) 335-5241

NPI assigned

Mar 7, 2006

Last updated

Jan 25, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brandi Gibbs

Title

Business Services Manager

Phone

(530) 335-5090

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891762985. Details of each certification follow.

• CCN 053845 Rural health clinic · Active · Details

Rural health clinic certification: CCN 053845

Legal name

PIT RIVER HEALTH SERVICE, INC.

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

May 13, 1981

Last certification

Aug 12, 2015

Ownership / control type

2B

Organization structure

CorporationNon-profit

Incorporated

Oct 1, 1979 in CA

Enrollment address

36977 Park Ave
Burney, CA 96013-4067

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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)…

All disclosed owners & managing parties 6

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

Practitioners 6

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.

• Yvette Jean Warren, RDHEF, AP, MA

  • Dental Hygienist
  • Burney, CA
  • NPI 1942899224
  NPD
• Lewis Edgar Furber Jr., FNP

  • Nurse Practitioner
  • Burney, CA
  • NPI 1013943620
  NPD (past)
• Kenneth M. Hazlewood, LMFT

  • Addiction (Substance Use Disorder) Counselor
  • Montague, CA
  • NPI 1164555306
  NPD (past)
• Richard Nielsen

  • Podiatrist
  • Susanville, CA
  • NPI 1417955113
  NPD (past)
• Tawana Nichole Nix, D.O.

  • Family Medicine Physician
  • Fall River Mills, CA
  • NPI 1649324294
  NPD (past)
• Dayna Rae Hochevar, P.A.

  • Medical Physician Assistant
  • Pueblo, CO
  • NPI 1356685747
  NPD (past)

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1891762985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36977 PARK AVE",
            "city": "BURNEY",
            "state": "CA",
            "postal_code": "960134067",
            "telephone_number": "530-335-5090",
            "fax_number": "530-335-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36977 PARK AVE",
            "city": "BURNEY",
            "state": "CA",
            "postal_code": "96013",
            "telephone_number": "530-335-5090",
            "fax_number": "530-335-5241"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 BIA #76A",
            "address_purpose": "LOCATION",
            "city": "ALTURAS",
            "state": "CA",
            "postal_code": "96101",
            "country_code": "US",
            "telephone_number": "530-233-3223",
            "fax_number": "530-233-3196",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 N Main St Ste E",
            "address_purpose": "LOCATION",
            "city": "Alturas",
            "state": "CA",
            "postal_code": "961013493",
            "country_code": "US",
            "telephone_number": "530-233-3328",
            "fax_number": "530-233-1902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PIT RIVER HEALTH SERVICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_title_or_position": "BUSINESS SERVICES MANAGER",
        "authorized_official_telephone_number": "530-335-5090"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "230000179",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "230000179",
            "primary": true
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountain Valleys Health Centers (Burney Alternative Health Center)
• Sean Andrew Munroe, MD
• Natalia P Orozco, FNP
• Henry Daniel Patterson, O.D., M.S.
• Jim Doyle Phipps, DC
• Gilda Jill Reed
• Right Road Recovery Programs, Inc
• Right Road Recovery Programs, Inc.
• Ruth Barbara Roeschlau, R.N.,P.H.N
• Keith Leroy Roper, PT

• Rural Health Clinic/Center in Burney, CA
• Providers in Burney, CA by specialty
• Rural Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.