NPIMap

Organization Active NPI

Peach Tree Healthcare

Doing business as Peach Tree Vision Chico

  • Federally Qualified Health Center (FQHC)
  • Chico, CA
National Provider Identifier
1922598226
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
55000248 Issued in CA
Legal business name
PEACH TREE HEALTHCARE
Doing business as
Peach Tree Vision Chico
Practice address
114 Mission Ranch Blvd Ste 50
Chico, CA 95926-5137
Phone
(530) 749-3242
Fax
(530) 749-3248
NPI assigned
May 14, 2018
Last updated
Aug 7, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PEACH TREE HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

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

Authorized official

Name
Mr. Greg Stone, CEO
Title
Ceo
Phone
(530) 749-3242

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 55000248 CA Primary

Addresses

Primary practice location

114 Mission Ranch Blvd Ste 50
Chico, CA 95926-5137

Mailing address

1114 Yuba St Ste 220
Marysville, CA 95901-4838
Phone (530) 749-3242

Other names 1

  • Peach Tree Vision Chico Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101104000566 CA Part B Supplier - Clinic/Group Practice 7416978440 Receives reassigned benefits from 61 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Olivehurst, CA; Yuba City, CA; Sacramento, CA; Marysville, CA; Live Oak, CA; Chico, CA
O20211206002479 CA Part A Provider - Federally Qualified Health Center (FQHC) 7416978440 Practice locations: Chico, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922598226. Details of each certification follow.

Federally qualified health center certification: CCN A01036

Legal name
PEACH TREE HEALTHCARE
Doing business as
PEACH TREE VISION CHICO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2021
Last certification
Dec 6, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 21, 1995 in CA
Enrollment address
114 Mission Ranch Blvd
Ste 50
Chico, CA 95926-5137

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 9

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

National Provider Directory

National Provider Directory
Part of
Peach Tree Clinic Inc

Locations

1114 Yuba St
Rm 144
Marysville, CA 95901

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Veronica Avila Individual W-2 Managing EmployeeController Jun 1, 2004
Leanne Link Individual Corporate DirectorBoard Secretary/Treasurer Mar 27, 2025
Robert Bendorf Individual Corporate DirectorBoard Vice Chair May 24, 2024
Emilio Flores Individual Corporate DirectorBoard Member Oct 9, 2025
Monika Lee Individual Corporate DirectorBoard Member Aug 29, 2024
Michelle Woodard Individual Corporate OfficerCoo Dec 3, 2024
W-2 Managing EmployeeAd; Jun 1, 2016
Ngoc-Phuong T Luu Individual Corporate DirectorBoard Member Apr 1, 2020
Renick House Individual Corporate DirectorBoard Member Feb 27, 2025
Chundeep Sidhu Individual Corporate DirectorBoard Member Sep 25, 2025
Tracie Riggs Individual Corporate OfficerCeo Feb 27, 2025
Gregory Barker Individual Corporate OfficerCfo Mar 13, 2025
Erika Laine Summers Individual Corporate DirectorBoard Chair Jul 1, 2020
Awni Allababidi Individual Corporate DirectorBoard Member Oct 1, 2017
Edward Anthony Kalpas Individual Corporate OfficerCmo Nov 10, 2025
Donald Blaser Individual Corporate DirectorBoard Member Feb 1, 2021

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Peach Tree North SacramentoSacramento, CA, CCN 751916 Federally qualified health center Operational/Managerial Control Jul 10, 2012
Peach Tree HealthcareYuba City, CA, CCN 921009 Federally qualified health center Operational/Managerial Control Feb 1, 2017

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1526256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691366400000",
    "number": "1922598226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1114 YUBA ST STE 220",
            "city": "MARYSVILLE",
            "state": "CA",
            "postal_code": "959014838",
            "telephone_number": "530-749-3242",
            "fax_number": "530-749-3248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 MISSION RANCH BLVD STE 50",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959265137",
            "telephone_number": "530-749-3242",
            "fax_number": "530-749-3248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH TREE HEALTHCARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEACH TREE HEALTHCARE",
        "enumeration_date": "2018-05-14",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-07",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "530-749-3242",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "55000248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peach Tree Vision Chico",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Peach Tree Vision Chico",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chico, CA

Sources for this page

Verify at the official NPI Registry.