Redwood Coast Medical Services, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

110000048 Issued in CA

Legal business name

REDWOOD COAST MEDICAL SERVICES, INC.

Practice address

46900 Ocean Dr
Gualala, CA 95445-8353

Phone

(707) 884-4005

Fax

(707) 884-9728

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Diane Agee

Title

Ceo

Phone

(707) 884-9476

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 051907

Legal name

REDWOOD COAST MEDICAL SERVICES, INC.

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 1, 1994

Last certification

Mar 1, 1994

Ownership / control type

For profit – partnership

Organization structure

CorporationNon-profit

Incorporated

Feb 28, 1977 in CA

Enrollment address

46900 Ocean Dr
Gualala, CA 95445-8353

Other NPIs with the same Medicare PAC ID 1

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

• Redwood Coast Medical Services, Inc.

  • Community Health Clinic/Center
  • Point Arena, CA
  • NPI 1275778847

  6901941905

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

• Redwood Coast Medical Services, Inc.

  • Community Health Clinic/Center
  • Point Arena, CA
  • NPI 1275778847

  O20100302000446

  Same enrollment

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

CLIA laboratory certificates

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.

Owners & managing parties with NPI records 1

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

• Gabriel F Ramirez, MD

  • Diagnostic Radiology Physician
  • Long Beach, CA
  • NPI 1336125020

  Corporate Officer

  CMS ownership

Practitioners 22

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

• Molly Jean Behrens, MFT

  • Marriage & Family Therapist
  • Vacaville, CA
  • NPI 1881203602

  CA

  Medicare reassignment Care Compare group NPD
• Natalie Susan Berg

  • Clinical Social Worker
  • Gualala, CA
  • NPI 1013644368

  CA

  Medicare reassignment Care Compare group NPD
• Thomas A. Bertolli, M.D.

  • Family Medicine Physician
  • Laytonville, CA
  • NPI 1811089717

  CA

  Medicare reassignment Care Compare group NPD
• Afsoon Foorohar, D.O.

  • Family Medicine Physician
  • Santa Rosa, CA
  • NPI 1962897645

  CA

  Medicare reassignment Care Compare group NPD
• Sona Weber, LCSW

  • Clinical Social Worker
  • Ukiah, CA
  • NPI 1932320850

  CA

  Medicare reassignment Care Compare group NPD
• Lois Falk, N.P.

  • Nurse Practitioner
  • Gualala, CA
  • NPI 1346332335

  CA

  Medicare reassignment NPD
• Olaf Kristian Golubjatnikov

  • Family Medicine Physician
  • Gualala, CA
  • NPI 1336900968

  CA

  Medicare reassignment NPD
• Holly Ramona Hamm, FNP-C

  • Family Nurse Practitioner
  • Gualala, CA
  • NPI 1285416123

  CA

  Medicare reassignment NPD
• Mark Kal, M.D.

  • Family Medicine Physician
  • Gualala, CA
  • NPI 1316937931

  CA

  Medicare reassignment NPD
• Andrew Steiger, LCSW

  • Clinical Social Worker
  • Santa Cruz, CA
  • NPI 1376639740

  CA

  Medicare reassignment NPD
• Pamela A. Tait, M.F.T.

  • Marriage & Family Therapist
  • Los Angeles, CA
  • NPI 1639408438

  CA

  Medicare reassignment NPD
• Katherine Robin Willems, FNP

  • Family Nurse Practitioner
  • Clearlake, CA
  • NPI 1134393069

  CA

  Medicare reassignment NPD

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387843200000",
    "number": "1962530725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1100",
            "city": "GUALALA",
            "state": "CA",
            "postal_code": "954451100",
            "telephone_number": "707-884-4005",
            "fax_number": "707-884-9728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46900 OCEAN DR",
            "city": "GUALALA",
            "state": "CA",
            "postal_code": "954458353",
            "telephone_number": "707-884-4005",
            "fax_number": "707-884-9728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDWOOD COAST MEDICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2013-12-24",
        "status": "A",
        "authorized_official_last_name": "AGEE",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "707-884-9476"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "110000048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03906F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Arnold Nelson, MD
• Northern California Medical Assoc Inc
• James Edwin Platt, D.C.
• Karenanne Leilani Radich, P.T.
• Roberta U. Rams, D.D.S.
• William M Schieve, L.AC.,D.C.
• Karen Petersen Scott
• Laundon Transue
• Lucinda Weaver I, M.P.T.
• Caithleen Paterson Zikorus, N.P.

• All providers in Gualala, CA
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.