ADVENTIST HEALTH CLEARLAKE HOSPITAL, INC (NPI# 1871063040) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871063040 |
| Entity Type | Organization |
| Organization Name | ADVENTIST HEALTH CLEARLAKE HOSPITAL, INC |
| Practice Address |
801 11th St Lakeport CA 95453-4100 |
| Mailing Address |
Po Box 6710 Clearlake CA 95422-6710 |
| Practice Telephone | 7072633746 |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2018-11-30 |
| 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 |
| Other Name | Type Code |
|---|---|
| Adventist Health Clear Lake | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093274508 | Adventist Health Clearlake Hospital, Inc | Clinic/Center | 6300 E. Highway 20, Lucerne, CA 95458 | 2019-03-14 |
| 1841626587 | Adventist Health Clearlake Hospital, Inc | General Acute Care Hospital | 9430 Lake St, Lower Lake, CA 95457-8600 | 2013-09-25 |
| 1215383047 | Adventist Health Clearlake Hospital, Inc | Clinic/Center | 900 King St, Arbuckle, CA 95912-0000 | 2016-05-11 |
| 1639151996 | Adventist Health Clearlake Hospital, Inc | Anesthesiology | 15630 18th Avenue, Clearlake, CA 95422-6710 | 2005-11-14 |
| Street Address |
801 11TH ST |
| City | LAKEPORT |
| State | CA |
| Zip Code | 95453-4100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932107828 | John Regis Minotti | Internal Medicine | 801 11th St, Lakeport, CA 95453-4100 | 2005-07-13 |
| 1174183784 | Adventist Health Physicians Network | Internal Medicine | 801 11th St, Lakeport, CA 95453-4100 | 2019-06-17 |
| 1194254995 | Jaques Ngakam | Physician Assistant | 801 11th St, Lakeport, CA 95453-8107 | 2017-06-06 |
| 1871640060 | Daniel Ayers | Chiropractor | 801 11th St, Lakeport, CA 95453 | 2007-01-03 |
| 1275630196 | Kraivit Angsupanich | Surgery | 801 11th St, Suite 1, Lakeport, CA 95453-4100 | 2006-09-20 |
| 1659387512 | David Betat | Family Medicine | 801 11th St, Lakeport, CA 95453-4100 | 2006-07-31 |
| 1912957242 | John Patrick Robertson | Internal Medicine | 801 11th St, Lakeport, CA 95453-4100 | 2006-05-10 |
| 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 |
|---|---|---|---|---|
| 1417027095 | Adventist Health Clearlake Hospital Inc | Clinic/Center | 487 S Main St, Lakeport, CA 95453-5315 | 2006-11-09 |
| 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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| 1881232676 | Madera Community Hospital | Clinic/Center | 121 Belmont Ave., Suite 101, Mendota, CA 93640 | 2019-12-12 |
| 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 |
| 1679038434 | Ridgecrest Regional Hospital | Clinic/Center | 105 E Sydnor Ave, Ridgecrest, CA 93555-5546 | 2019-02-06 |
| Find all providers with the same taxonomy | ||||
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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.