NPIMap

Organization Active NPI

Sonora Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Sonora, CA
National Provider Identifier
1992796593
Registry record updated Apr 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
SONORA COMMUNITY HOSPITAL
Practice address
1000 Greenley Rd
Sonora, CA 95370-5200
Phone
(209) 536-3859
Fax
(209) 533-7696
NPI assigned
Nov 2, 2005
Organization subpart
Yes
Parent organization
SONORA COMMUNITY HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2013

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

Authorized official

Name
Andrew D. Jahn
Title
Vice President for Finance
Phone
(209) 536-5011

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

1000 Greenley Rd
Sonora, CA 95370-5200

Mailing address

14542 Lolly LN
Sonora, CA 95370-9226
Phone (209) 536-3900

Other identifiers 1

IdentifierTypeStateIssuer
ZZZC5502ZOtherCABLUE CROSS/BLUE SHIELD

Other names 1

  • Transitional Care Unit Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100826000104 CA Part A Provider - Hospital 4284538505 Practice locations: Sonora, CA

Hospital certification: CCN 05U335

Legal name
SONORA COMMUNITY HOSPITAL
Doing business as
ADVENTIST HEALTH SONORA
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1958 in CA
Enrollment address
179 Fairview LN
Sonora, CA 95370-4809
Hospital Swing-Bed Unit
Hospital subgroups
Long-term, Swing-bed approved

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

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Kerry L Heinrich Individual Corporate OfficerChair Jan 1, 2022
Corporate DirectorBoard Member Dec 15, 2014
John H Cress Individual Corporate DirectorBoard Member Jan 1, 2024
Meredith S Jobe Individual Corporate OfficerSecretary Mar 31, 2014
Eric a Stevens Individual Corporate OfficerVice Chair Mar 5, 2025
Richard K Reiner Individual Corporate DirectorBoard Member Jan 16, 2017
Joy a. Fehr Individual Corporate DirectorBoard Member Oct 1, 2020
Jonathan J Daggett Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew R Davis Individual Corporate DirectorBoard Member May 5, 2017
Ann K Beckett Individual Corporate DirectorBoard Member Jan 1, 2024
Marc K Woodson Individual Corporate DirectorBoard Member Jan 1, 2019
John C Freedman Individual Corporate DirectorBoard Member Sep 26, 2016
Gregory D McCulloch Individual Corporate OfficerPresident May 29, 2024
W-2 Managing EmployeePresident May 5, 2014
Jack W Wagner Individual Corporate DirectorBoard Member Dec 1, 2022
Kenneth Jutzy Individual Corporate DirectorBoard Member Jan 1, 2024
Bradford C Newton Individual Corporate DirectorBoard Member Aug 16, 2021
Robert a Cherry Individual Corporate DirectorBoard Member May 5, 2017
Larry L Innocent Individual Corporate DirectorBoard Member Sep 19, 2011
Adventist Health System/West Organization, Roseville, CA Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jun 16, 1980
Operational/Managerial Control Jun 16, 1980 100%
Jeffrey Shultz Individual Corporate OfficerTreasurer Aug 19, 2024

National Provider Directory

National Provider Directory
Tax ID family
Sonora Community Hospit7 organizations share this tax ID, including this one
Part of
Sonora Community Hospit

Other organizations with this tax ID 6

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

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 9

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

Facilities with the same owner 105

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

View all 105

Practitioners 134

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

View all 134

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365379200000",
    "number": "1992796593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14542 LOLLY LN",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953709226",
            "telephone_number": "209-536-3900",
            "fax_number": "209-533-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 GREENLEY RD",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705200",
            "telephone_number": "209-536-3859",
            "fax_number": "209-533-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SONORA COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SONORA COMMUNITY HOSPITAL",
        "enumeration_date": "2005-11-02",
        "last_updated": "2013-04-08",
        "status": "A",
        "authorized_official_last_name": "JAHN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "VICE PRESIDENT FOR FINANCE",
        "authorized_official_telephone_number": "209-536-5011"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "ZZZC5502Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Transitional Care Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.