NPIMap

Organization Active NPI

Colusa Medical Center, LLC

  • Rural Health Clinic/Center
  • Red Bluff, CA
National Provider Identifier
1972072163
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COLUSA MEDICAL CENTER, LLC
Practice address
645 Antelope Blvd Ste 24
Red Bluff, CA 96080-2463
Phone
(530) 619-0800
NPI assigned
Nov 16, 2018
Organization subpart
Yes
Parent organization
COLUSA MEDICAL CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Authorized official

Name
Tammy Jean Thompson
Title
Executive VP/Cfo
Phone
(209) 287-6308

Specialties & licenses 1

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

Addresses

Primary practice location

645 Antelope Blvd Ste 24
Red Bluff, CA 96080-2463

Mailing address

199 E Webster St
Colusa, CA 95932-2954

Other names 1

  • Red Bluff Health Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200518000608 CA Part A Provider - Rural Health Clinic 4183901978 Practice locations: Red Bluff, CA

Rural health clinic certification: CCN 058722

Legal name
COLUSA MEDICAL CENTER, LLC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2019
Last certification
Dec 8, 2016
Ownership / control type
1B
Organization structure
LLCProprietary
Incorporated
Sep 8, 2016 in CA
Enrollment address
645 Antelope Blvd
Ste 24
Red Bluff, CA 96080-2463
Related CCNs
050783

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

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Colusa Medical Center LLC10 organizations share this tax ID, including this one
Part of
Colusa Medical Center LLC

Other organizations with this tax ID 9

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Gurpreet Singh Randhawa Individual 5% Or Greater Direct Ownership Interest Sep 8, 2016 100%
Corporate OfficerCeo Sep 8, 2016 100%
Jagraj S Nijjar Individual Corporate OfficerBoard Member Jan 1, 2019
Santo a Mirza Individual W-2 Managing Employee Dec 1, 2019
Lauren C Still Individual W-2 Managing EmployeeQuality Coordinator Nov 26, 2019
Colusa Medical Center, LLC Organization, Colusa, CA LLC 5% Or Greater Direct Ownership Interest Jan 1, 2019 100%
Amy C Micheli Individual Corporate OfficerCoo/Cno Jan 1, 2019
W-2 Managing EmployeeCoo/Cno Jan 1, 2019
Shamsher Bhullar Individual Corporate OfficerAcno Jan 1, 2019
W-2 Managing EmployeeAcno Jan 1, 2019
Kabul Singh Individual Corporate OfficerBoard Member Jan 1, 2019

Owners & managing parties with NPI records 14

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

View all 14

All facility ownership & control disclosures 10

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

FacilityTypeRoleSince
Colusa Medical Center - AcuteColusa, CA, CCN 050783 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center-AcuteColusa, CA, CCN 05U783 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center - SNFColusa, CA, CCN 555909 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 1, 2019
Jun 27, 2018
Colusa Medical CenterWilliams, CA, CCN 058696 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical CenterArbuckle, CA, CCN 058695 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical CenterColusa, CA, CCN 058697 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Colusa Medical Center, LLCOrland, CA, CCN 058720 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
First Care Medical AssociatesOrland, CA, CCN 058922 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2019
Glenn Family Medical GroupWillows, CA, CCN 058572 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2025
Family Care CenterWillows, CA, CCN 053981 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2025

Owned or controlled facilities with NPI records 9

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

Facilities with the same owner 9

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

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2019 Change of OwnershipThis provider was the buyer Frontier Village Family Health Center, IncCCN 553909, CA, NPI 1477667384

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1542326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1972072163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 E WEBSTER ST",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "959322954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 ANTELOPE BLVD STE 24",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802463",
            "telephone_number": "530-619-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLUSA MEDICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLUSA MEDICAL CENTER, LLC",
        "enumeration_date": "2018-11-16",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "EXECUTIVE VP/CFO",
        "authorized_official_telephone_number": "209-287-6308"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Bluff Health Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Red Bluff Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Red Bluff, CA

Sources for this page

Verify at the official NPI Registry.