NPIMap

Organization Active NPI

Enloe Medical Center

  • Rehabilitation Hospital Unit
  • Chico, CA
National Provider Identifier
1982787016
Registry record updated May 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
License
230000027 Issued in CA
Legal business name
ENLOE MEDICAL CENTER
Practice address
340 W East Ave
Chico, CA 95926-7238
Phone
(530) 893-7300
Fax
(530) 893-6853
NPI assigned
Oct 23, 2006
Last updated
May 28, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
ENLOE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 28, 2014

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

Authorized official

Name
Mr. Myron Eugene Machula
Title
VP/Cfo
Phone
(530) 332-7357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 230000027 CA Primary

Addresses

Primary practice location

340 W East Ave
Chico, CA 95926-7238

Mailing address

1531 Esplanade
Attn: Finance
Chico, CA 95926-3310
Phone (530) 332-7479

Other identifiers 2

IdentifierTypeStateIssuer
ZZR00039FMedicaidCA
05T039OtherCAMEDICARE ID TYPE UNSPECIFIED

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100621000922 CA Part A Provider - Hospital 9739092388 Practice locations: Chico, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982787016. Details of each certification follow.

Hospital certification: CCN 05T039

Legal name
ENLOE MEDICAL CENTER
Doing business as
ENLOE MEDICAL CENTER REHAB
Organization structure
CorporationNon-profit
Incorporated
Jun 16, 1965 in CA
Enrollment address
340 W East Ave
Chico, CA 95926-7238
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Enloe Rehabilitation CenterCCN 05T039 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Enloe General Colorectal S18 organizations share this tax ID, including this one
Part of
Enloe General Colorectal S

Other organizations with this tax ID 17

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

View all 17

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
Marsha Martin Individual Corporate DirectorBoard Member Jan 1, 2005
Charles S Merriman Individual Corporate DirectorBoard Member Jan 1, 2011
Thomas Lando Individual Corporate DirectorBoard Chair Jan 1, 2007
Kevin Woodward Individual Corporate DirectorVP/Cfo Jan 1, 2019
W-2 Managing EmployeeVP/Cfo Jan 1, 2019
James B Boice Individual Corporate DirectorBoard Member Jan 1, 2012
Warren Brusie Individual Corporate DirectorBoard Member Jan 1, 2005
Michael Wiltermood Individual Corporate OfficerCeo/President Oct 1, 2010
Corporate DirectorCeo/President Oct 1, 2010
W-2 Managing EmployeeCeo/President Oct 1, 2010
Carol Huston Individual Corporate DirectorBoard Secretary Jan 1, 2012
Matthews Jackson Individual Corporate DirectorBoard Member Jan 1, 2007
Eric Larrabee Individual Corporate DirectorBoard Member Jan 1, 2007
Judy Sitton Individual Corporate DirectorBoard Vice Chair Jan 1, 2005
Cindy Foor Individual Corporate DirectorBoard Member Jan 1, 2013
Monroe Alan Sprague Individual Corporate DirectorBoard Member Jan 1, 2008

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401235200000",
    "number": "1982787016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1531 ESPLANADE",
            "address_2": "ATTN: FINANCE",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959263310",
            "telephone_number": "530-332-7479",
            "fax_number": "530-893-6853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 W EAST AVE",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959267238",
            "telephone_number": "530-893-7300",
            "fax_number": "530-893-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENLOE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ENLOE MEDICAL CENTER",
        "enumeration_date": "2006-10-23",
        "last_updated": "2014-05-28",
        "status": "A",
        "authorized_official_last_name": "MACHULA",
        "authorized_official_first_name": "MYRON",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "530-332-7357",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "CA",
            "license": "230000027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR00039F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID TYPE UNSPECIFIED",
            "identifier": "05T039",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chico, CA

Sources for this page

Verify at the official NPI Registry.