NPIMap

Organization Active NPI

Hazel Hawkins Memorial Hospital

  • Rural Health Clinic/Center
  • San Juan Bautista, CA
National Provider Identifier
1891811907
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
070000004 Issued in CA
Legal business name
HAZEL HAWKINS MEMORIAL HOSPITAL
Practice address
301 The Alameda
Suite B3
San Juan Bautista, CA 95045-9746
Phone
(831) 623-4615
Fax
(831) 623-4689
NPI assigned
Mar 21, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mrs. Mary Casillas
Title
Ceo
Phone
(831) 636-2604

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 1

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

Other NPIs with the same Medicare PAC ID 7

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

Practitioners 54

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

View all 54

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1025239Hazel Hawkins Health Clinic301 The Alameda, Ste B-3, San Juan Bautista, CA 95045Provider-performed microscopyMay 2, 2028

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030321000062 CA Part a Provider - Rural Health Clinic 9133038326 1 other NPI on this enrollment
Practice locations: San Juan Bautista, CA

Rural health clinic certification: CCN 058590

Medicare enrollment files
Legal name
HAZEL HAWKINS MEMORIAL HOSPITAL
Doing business as
HAZEL HAWKINS HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 17, 2003
Last certification
Jun 10, 2015
Ownership / control type
Non-profit – church related
Organization structure
OtherProprietary
Enrollment address
301 The Alameda
Ste B-3
San Juan Bautista, CA 95045-9746
Related CCNs
050296

All disclosed owners & managing parties 4

Medicare enrollment files

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

NameRoleSinceShare
Jerrianne M Hernandez Individual Corporate DirectorBoard Member Nov 1, 2016
Mary T Casillas Individual Corporate OfficerCeo Oct 27, 2022
W-2 Managing EmployeeCeo Oct 27, 2022
Josefa Sanchez Individual Corporate DirectorBoard Member Nov 1, 2014
Mark T Robinson Individual Corporate OfficerCfo Feb 19, 2001
W-2 Managing Employee Feb 19, 2001

All facility ownership & control disclosures 2

Medicare enrollment files

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

FacilityTypeRoleSince
Mabie First Street Healthcare CenterHollister, CA, CCN 058660 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2012
Barragan Family Health Care and Diabetes CenterHollister, CA, CCN 058705 Rural health clinic Operational/Managerial Control (100%) Dec 15, 2005

National Provider Directory

National Provider Directory
Tax ID family
Hazel Hawkins Mem10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

930 Sunset Dr
Ste 3
Hollister, CA 95023
Phone (831) 636-2664

930 Sunset Dr
Hollister, CA 95023
Phone (650) 248-8481

890 Sunset Dr
Ste 2AA
Hollister, CA 95023

890 Sunset Dr
Bldg A
Hollister, CA 95023
Phone (831) 635-9788

890 Sunset Dr
Ste A2A
Hollister, CA 95023
Phone (781) 340-0735

890 Sunset Dr
Ste 3
Hollister, CA 95023

301 The Alameda
Spc B3
San Juan Bautista, CA 95045

301 The Alameda
Ste B3
San Juan Bautista, CA 95045
Phone (831) 623-4615

301 The Alameda
Unit 3
San Juan Bautista, CA 95045

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 070000004 CA Primary

Addresses

NPPES NPI Registry

Primary practice location

301 The Alameda
Suite B3
San Juan Bautista, CA 95045-9746

Mailing address

911 Sunset Dr
Hollister, CA 95023-5602
Phone (831) 637-5711

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
RHM08590FMedicaidCA

Other names 1

NPPES NPI Registry
  • HAZEL HAWKINS HEALTH CLINIC Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 11, 2024.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1891811907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 SUNSET DR",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950235602",
            "telephone_number": "831-637-5711",
            "fax_number": "831-637-3126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 THE ALAMEDA",
            "address_2": "SUITE B3",
            "city": "SAN JUAN BAUTISTA",
            "state": "CA",
            "postal_code": "950459746",
            "telephone_number": "831-623-4615",
            "fax_number": "831-623-4689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAZEL HAWKINS MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "CASILLAS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "831-636-2604",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "070000004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM08590F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAZEL HAWKINS HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Juan Bautista, CA

Sources for this page

Verify at the official NPI Registry.