Winters Healthcare Foundation, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Winters, CA
NPI 1992736086 · NPPES record last updated Aug 19, 2020
Key facts
- NPI
- 1992736086
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- WINTERS HEALTHCARE FOUNDATION, INC.
- Practice address
- 172 E Grant Ave
Winters, CA 95694-1780 - Phone
- (530) 795-4377
- Fax
- (530) 795-9541
- NPI assigned
- Jul 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Christopher Kelsch
- Title
- Executive Director
- Phone
- (530) 795-4377
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Subparts reporting this organization as parent 3
Practitioners 7
-
Virginia Anne Leone, MD, MPH
-
Jesus Javier Luna, PH.D.
-
Ashley Evans, NP
-
Jaime Lopez, P.A.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0976887 | Winters Healthcare Clinic | Provider-performed microscopy | Aug 15, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 051022
- Legal name
- WINTERS HEALTHCARE FOUNDATION, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 23, 2005
- Last certification
- Sep 23, 2005
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 172 E Grant Ave
Winters, CA 95694-1780
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Jacquelyn Knabke |
Corporate Director | Mar 28, 2024 | |
| Erik Brunkal |
Corporate Director | Apr 1, 2011 | |
| Clara Saunders |
Corporate Director | Mar 28, 2024 | |
| Jennifer Sierras |
Corporate Director |
Mar 28, 2024 | |
| Monika T Brunkal |
Corporate Director |
Jan 1, 2014 | |
| Lucila G Escamilla |
Corporate Director | Jan 1, 2017 | |
| Osbaldo Arce |
Corporate Director |
Mar 28, 2024 | |
| Jennifer Jacobs Garcia |
Corporate Director | Oct 1, 2015 | |
| Andres Bermudez |
Corporate Director | Dec 3, 2025 | |
| Christopher Kelsch |
Corporate Director |
Jun 1, 2005 | |
| W-2 Managing Employee | Jul 1, 2005 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050803000213 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 2567490238 | Practice locations: Winters, CA |
| O20070426000372 | CA | Part B Supplier - Clinic/Group Practice | 2567490238 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment Practice locations: Esparto, CA; Winters, CA |
National Provider Directory
Locations
172 E Grant Ave
Winters, CA 95694
Phone (530) 212-1025
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
172 E Grant Ave
Winters, CA 95694-1780
Mailing address
172 E Grant Ave
Winters, CA 95694-1780
Phone (530) 795-4377
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 030000787 | Other | CA | STATE LICENSE |
| HAP71037F | Medicaid | CA | |
| ZZZ04589Z | Other | CA | MEDICARE PTAN |
| 2254671 | Other | CA | STATE CORPORATION NUMBER |
| BCP71037F | Medicaid | CA | |
| FHC71037F | Medicaid | CA |
Other names
- Winters Healthcare Clinic
Other providers in Winters, CA
- Linda Tsang
- Brittany N Vacura Sarris
- Viridiana Simona Van Den Hengel-Gomez
- We Care 4 Yolo LLC
- Winters Healthcare Foundation, Inc.
- Winters Joint Unified School District
- Kate A Woodard
- Woodland Care Pharmacy and Medical Supply LLC
All providers in Winters, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.