ADVENTIST HEALTH CLEARLAKE HOSPITAL INC (NPI# 1417027095) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417027095 |
| Entity Type | Organization |
| Organization Name | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC |
| Other Organization Name | ADVENTIST HEALTH CLEAR LAKE |
| Practice Address |
487 S Main St Lakeport CA 95453-5315 |
| Mailing Address |
Po Box 398837 San Francisco CA 94139-8837 |
| Practice Telephone | 7072634631 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2020-02-20 |
| Authorized Official Name | CARLTON EDWARD JACOBSON (CFO) |
| Authorized Official Telephone | 7079955824 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | HSP40301F | 05 |
| Other Name | Type Code |
|---|---|
| Adventist Health Clear Lake | Doing Business As Name - Organization |
| Adventist Health Ukiah Valley | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477104099 | Adventist Health Clearlake Hospital Inc | Clinic/Center | 15322 Lakeshore Drive, Suite 101, 102 and 201, Clearlake, CA 95422 | 2019-09-25 |
| 1609222512 | Adventist Health Clearlake Hospital Inc | Clinic/Center | 501 E St, Williams, CA 95987-5810 | 2016-05-10 |
| 1508212424 | Adventist Health Clearlake Hospital Inc | Clinic/Center | 151 E Webster St, Colusa, CA 95932-2949 | 2016-05-10 |
| 1558737486 | Adventist Health Clearlake Hospital Inc | Clinic/Center | 18990 Coyote Valley Rd, Hidden Valley Lake, CA 95467-8337 | 2015-08-14 |
| Street Address |
487 S MAIN ST |
| City | LAKEPORT |
| State | CA |
| Zip Code | 95453-5315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417340555 | Adventist Health Physicians Network | Clinic/Center | 487 S Main St, Lakeport, CA 95453-5315 | 2015-03-13 |
| 1386820322 | Loretta Ancellotti | Nurse Practitioner | 487 S Main St, Suite 122, Lakeport, CA 95453-5315 | 2008-01-19 |
| 1720148067 | Barbara S Gardner | Pediatrics | 487 S Main St, Lakeport, CA 95453-5315 | 2006-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427526847 | Easter Seals Bay Area | Early Intervention Provider Agency | 1950 Parallel Drive, Lakeport, CA 95453 | 2018-11-03 |
| 1285000810 | Lake County Tribal Health Consortium, Inc. | Clinic/Center | 14678 Lakeshore Boulevard, Clearlake, CA 95453 | 2015-08-18 |
| 1942558721 | Lorena A Watson | Nurse Practitioner | 5108 Hill Road East, Lakeport, CA 95453 | 2012-08-27 |
| 1992024657 | Jennifer Stolworthy Smith | Case Manager/Care Coordinator | 991 Parallel Dr. Ste. B, County of Lake, Mental Health, Lakeport, CA 95453 | 2010-05-20 |
| 1376720664 | June Arisa Masato | Marriage & Family Therapist | 1152 S. Main St, Lakeport, CA 95453 | 2008-01-29 |
| 1245417021 | Robert Ryan Taylor Sr. | Physical Therapist | 1285 S Main Street, Lakeport, CA 95453 | 2008-01-24 |
| 1760669618 | Joan Kammerer | Registered Nurse | 922 Bevins Court, Lakeport, CA 95453 | 2008-01-23 |
| 1881878353 | Mary Theresa Mcmillan | Marriage & Family Therapist | 75 Fourth Street, Lakeport, CA 95453 | 2007-12-19 |
| 1922288984 | Robert William Krause | Family Medicine | 755 Eleventh St, Lakeport, CA 95453 | 2007-11-07 |
| 1568683092 | Dan Sleeth | Marriage & Family Therapist | 991 Parallel Dr., Lakeport, CA 95453 | 2007-05-01 |
| Find all providers in zip 95453 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871063040 | Adventist Health Clearlake Hospital, Inc | Clinic/Center | 801 11th St, Lakeport, CA 95453-4100 | 2018-11-30 |
| 1831597517 | Sutter West Bay Hospitals | Clinic/Center | 5176 Hill Rd E, Modular Building, Lakeport, CA 95453-6300 | 2014-12-12 |
| 1770816829 | Sutter Bay Hospitals | Clinic/Center | 5176 Hill Rd E, Lakeport, CA 95453-6300 | 2009-09-08 |
| 1700119856 | Sutter West Bay Hospitals | Clinic/Center | 5176 Hill Rd E, Lakeport, CA 95453-6300 | 2009-09-08 |
| 1073745337 | Sutter Lakeside Hospital | Clinic/Center | 5176 Hill Rd E, Lakeport, CA 95453-6300 | 2009-08-19 |
| 1053495879 | Sutter Lakeside Hospital | Clinic/Center | 5176 Hill Rd E, Lakeport, CA 95453-6300 | 2006-10-25 |
| 1407962459 | Sutter Lakeside Hospital | Clinic/Center | 5176 Hill Rd E, Lakeport, CA 95453-6300 | 2006-08-22 |
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| 1790331817 | Valley Healthcare Centers | Clinic/Center | 252 N Highway 65, Lindsay, CA 93247-2702 | 2019-08-14 |
| 1093274508 | Adventist Health Clearlake Hospital, Inc | Clinic/Center | 6300 E. Highway 20, Lucerne, CA 95458 | 2019-03-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.