Good Samaritan Hospital Ca LTD PTP
Organization Active NPI Rural Health Clinic/Center · Shafter, CA
NPI 1942024930 · NPPES record last updated Nov 15, 2024
Key facts
- NPI
- 1942024930
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- GOOD SAMARITAN HOSPITAL CA LTD PTP
- Practice address
- 801 Santa Fe Way
Shafter, CA 93263-3158 - Phone
- (661) 215-7500
- NPI assigned
- Nov 14, 2024
- Organization subpart
- No
Authorized official
- Name
- Gerrie Halbrook
- Title
- Cfo
- Phone
- (661) 215-7500
Owners & managing parties with NPI records 6
-
Mandeep Singh Bagga, M.D.
-
Harjeet S Brar, M.D.
-
Matab Singh, MD
Owned or controlled facilities with NPI records 3
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 3
Related certifications (CCN) 1
Facilities with the same owner 3
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2320353 | Good Samaritan Health Center Shafer | Certificate of waiver | Mar 16, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Rural health clinic certification: CCN 058733
- Legal name
- GOOD SAMARITAN HOSPITAL CA LTD PTP
- Doing business as
- GOOD SAMARITAN HEALTH CENTER SHAFTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 18, 2026
- Last certification
- Feb 18, 2026
- Ownership / control type
- 1C
- Organization structure
- Other · Proprietary
- Enrollment address
- 801 Santa Fe Way
Shafter, CA 93263-3158 - Related CCNs
- 050257
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Mandeep Singh Bagga |
Operational/Managerial Control |
May 21, 2019 | |
| Good Samaritan Hospital Ca LTD PTP |
5% Or Greater Direct Ownership Interest | Oct 30, 2023 | |
| Operational/Managerial Control | Oct 30, 2023 | ||
| Matab Singh |
Corporate Officer |
May 1, 2019 | |
| Operational/Managerial Control | May 1, 2019 | ||
| Geraldine Halbrook |
Corporate Officer |
May 26, 2019 | |
| Operational/Managerial Control | May 26, 2019 | ||
| Jagdeep Kaur Dillon |
Corporate Officer |
Aug 16, 2021 | |
| W-2 Managing Employee |
Aug 16, 2021 | ||
| Operational/Managerial Control |
Aug 16, 2021 | ||
| Harjeet Brar |
Corporate Officer |
May 1, 2019 | |
| Corporate Director | May 1, 2019 |
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Good Samaritan Hospital, LP |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2021 |
| Good Samaritan Health Center Wasco |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Feb 1, 2021 Feb 1, 2021 |
| Good Samaritan Arvin Medical Clinic |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 2023 Oct 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250703002548 | CA | Part a Provider - Rural Health Clinic | 1355308867 | Practice locations: Shafter, CA |
National Provider Directory
- Tax ID family
- Good Samaritan Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
801 Santa Fe Way
Shafter, CA 93263-3158
Mailing address
901 Olive Dr
Bakersfield, CA 93308-4144
Phone (661) 215-7500
Other names
- Good Samaritan Health Center Shafter
Other providers in Shafter, CA
- Alicia E Garcia
- Desiree Garza
- Glinn and Giordano Physical Therapy Inc.
- Bernadette Lynne Advincula Gonzalez
- Kimberly Gonzalez
- Grow Public Schools
- Sophia Medina Guerra
- Harmonia Birth Doula LLC
- Angela D Hernandez
- Shimeaka Danielle-Garrett Hodges
All providers in Shafter, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.