Pit River Health Service, Inc.

Key facts

NPI

1891762985

Entity type

Organization (NPI type 2)

Primary specialty

Rural Health Clinic/Center 261QR1300X

License

230000179 (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

Organization subpart

No

Authorized official

Name

Brandi Gibbs

Title

Business Services Manager

Phone

(530) 335-5090

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• 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)

Laboratory certificates & supplier records

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

CLIA laboratory certificates

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CA

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

Corporation · Non-profit

Incorporated

Oct 1, 1979 in CA

Enrollment address

36977 Park Ave
Burney, CA 96013-4067

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.

Medicare enrollment records

National Provider Directory

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD
  Plans: 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)…

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 25, 2023.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "THP00001F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Burney, CA · Rural Health Clinic/Center in California