NPIMap

Organization Active NPI

Ridgecrest Regional Hospital

Doing business as Ridgecrest Regional Hospital Rural Health Clinic

  • Rural Health Clinic/Center
  • Ridgecrest, CA
National Provider Identifier
1972813087
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
RIDGECREST REGIONAL HOSPITAL
Doing business as
Ridgecrest Regional Hospital Rural Health Clinic
Practice address
1111 N China Lake Blvd
Ridgecrest, CA 93555-3131
Phone
(760) 499-3855
Fax
(760) 499-3870
NPI assigned
Oct 8, 2010
Last updated
Apr 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Authorized official

Name
James A Suver
Title
Ceo
Phone
(760) 499-3900

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Multi-Specialty Clinic/Center 261QM1300X
Rural Health Clinic/Center 261QR1300X Primary
Rural Acute Care Hospital 282NR1301X 120000186 CA
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

1111 N China Lake Blvd
Ridgecrest, CA 93555-3131

Mailing address

1081 N China Lake Blvd
Ridgecrest, CA 93555-3130
Phone (760) 499-3902

Other names 1

  • Ridgecrest Regional Hospital Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090819000292 CA Part A Provider - Rural Health Clinic 9739099896 1 other NPI on this enrollment
Practice locations: Ridgecrest, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972813087. Details of each certification follow.

Rural health clinic certification: CCN 058655

Legal name
RIDGECREST REGIONAL HOSPITAL
Doing business as
RIDGECREST REGIONAL HOSPITAL RURAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 25, 2010
Last certification
May 22, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 1962 in CA
Enrollment address
1111 N China Lake Blvd
Ste 190
Ridgecrest, CA 93555-3131
Related CCNs
051333

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

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 1

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

National Provider Directory

National Provider Directory
Tax ID family
Ridgecrest Community11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1081 N China Lake Blvd
Ridgecrest, CA 93555
Phone (760) 446-0616

1111 N China Lake Blvd
#A
Ridgecrest, CA 93555

1111 N China Lake Blvd
Ste 201
Ridgecrest, CA 93555

1111 N China Lake Blvd
Ste 301
Ridgecrest, CA 93555
Phone (760) 446-3338

1111 N China Lake Blvd
Ste 501
Ridgecrest, CA 93555
Phone (760) 499-3846

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Christopher Ellis Individual Corporate DirectorChairman of the Board May 1, 2021
Judith Tharp Individual Corporate DirectorDirector May 20, 2022
Dana Lyons Individual Corporate DirectorBoard Member May 1, 2018
James a Suver Individual Corporate OfficerCeo Feb 17, 2009 100%
Operational/Managerial ControlCeo Feb 17, 2009 100%
Lawrence N Cosner Individual Corporate DirectorBoard Member May 1, 2023
Kimberly a Lock Individual W-2 Managing EmployeeProvider Enrollment Manager Dec 2, 2015
James Rizzardini Individual Corporate DirectorBoard Member May 1, 2019
Shrooq Abu-Issa Individual Corporate DirectorBoard Member May 1, 2021
Anita L Read Individual Corporate DirectorBoard Member May 1, 2017
Margaret M Hannon Individual Corporate DirectorBoard Member May 1, 2017
George Haslam Individual Corporate DirectorBoard Member May 1, 2016
Martha Hoppus Individual Corporate DirectorBoard Member May 20, 2022
Paige Sorbo Individual Corporate DirectorBoard Member May 1, 2017

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 5

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

FacilityTypeRoleSince
Ridgecrest Regional HospitalRidgecrest, CA, CCN 05Z333 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 11, 2012
Ridgecrest Obstetrics ClinicRidgecrest, CA, CCN 058699 Rural health clinic Operational/Managerial Control (100%) Sep 17, 2016
RRH Mobile Health ClinicRidgecrest, CA, CCN 058709 Rural health clinic Operational/Managerial Control (100%) Sep 29, 2016
Southern Sierra Medical ClinicRidgecrest, CA, CCN 058712 Rural health clinic Operational/Managerial Control (100%) Jun 1, 2019
China Lake Community Health ClinicRidgecrest, CA, CCN 058726 Rural health clinic Operational/Managerial Control (100%) Jun 1, 2020

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1972813087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1081 N CHINA LAKE BLVD",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935553130",
            "telephone_number": "760-499-3902",
            "fax_number": "760-446-2254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 N CHINA LAKE BLVD",
            "city": "RIDGECREST",
            "state": "CA",
            "postal_code": "935553131",
            "telephone_number": "760-499-3855",
            "fax_number": "760-499-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGECREST REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-08",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "SUVER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-499-3900"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "CA",
            "license": "120000186",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ridgecrest Regional Hospital Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ridgecrest Regional Hospital Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ridgecrest, CA

Sources for this page

Verify at the official NPI Registry.