NPIMap

Organization Active NPI

Good Samaritan Hospital Ca LTD PTP

  • Rural Health Clinic/Center
  • Shafter, CA
National Provider Identifier
1942024930
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 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
Last updated
Nov 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Authorized official

Name
Gerrie Halbrook
Title
Cfo
Phone
(661) 215-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

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 1

  • Good Samaritan Health Center Shafter Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250703002548 CA Part A Provider - Rural Health Clinic 1355308867 Practice locations: Shafter, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942024930. Details of each certification follow.

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
OtherProprietary
Enrollment address
801 Santa Fe Way
Shafter, CA 93263-3158
Related CCNs
050257

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

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
05D2320353Good Samaritan Health Center Shafer801 Santa Fe Wy, Shafter, CA 93263Certificate of waiverMar 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Alliance Community Hosp4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

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.

NameRoleSinceShare
Mandeep Singh Bagga Individual Operational/Managerial ControlMedical Director, Behavioral Health May 21, 2019
Good Samaritan Hospital Ca LTD PTP Organization, Bakersfield, CA For-profit 5% Or Greater Direct Ownership Interest Oct 30, 2023
Operational/Managerial Control Oct 30, 2023
Matab Singh Individual Corporate OfficerChief of Staff May 1, 2019
Operational/Managerial Control May 1, 2019
Geraldine Halbrook Individual Corporate OfficerCfo May 26, 2019
Operational/Managerial Control May 26, 2019
Jagdeep Kaur Dillon Individual Corporate OfficerCeo Aug 16, 2021
W-2 Managing EmployeeAd; Aug 16, 2021
Operational/Managerial ControlCeo Aug 16, 2021
Harjeet Brar Individual Corporate OfficerPresident May 1, 2019
Corporate Director May 1, 2019

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Good Samaritan Hospital, LPBakersfield, CA, CCN 050257 Hospital 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2021
Good Samaritan Health Center WascoWasco, CA, CCN 058725 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 1, 2021
Feb 1, 2021
Good Samaritan Arvin Medical ClinicArvin, CA, CCN 058963 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2023
Oct 1, 2023

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1731542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731628800000",
    "number": "1942024930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 OLIVE DR",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933084144",
            "telephone_number": "661-215-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 SANTA FE WAY",
            "city": "SHAFTER",
            "state": "CA",
            "postal_code": "932633158",
            "telephone_number": "661-215-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOSPITAL CA LTD PTP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-14",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A",
        "authorized_official_last_name": "HALBROOK",
        "authorized_official_first_name": "GERRIE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "661-215-7500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Samaritan Health Center Shafter",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Shafter, CA

Sources for this page

Verify at the official NPI Registry.