ADVENTIST HEALTH CLEARLAKE HOSPITAL INC. (NPI# 1124018031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124018031 |
| Entity Type | Organization |
| Organization Name | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC. |
| Other Organization Name | ST. HELENA HOSPITAL-CLEARLAKE |
| Practice Address |
15630 18th Ave Clearlake CA 95422-6710 |
| Mailing Address |
Po Box 6710 Clearlake CA 95422-6710 |
| Practice Telephone | 7079946486 |
| Practice Fax Number | 7079953631 |
| Mailing Telephone | 7079946486 |
| Mailing Fax Number | 7079953631 |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2012-04-26 |
| Authorized Official Name | MR. CARLTON JACOBSON (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 7079955820 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 282NC0060X |
General Acute Care Hospital Specialization: Critical Access |
110000174 | CA | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | ZZR00539G | 05 | |
| CA | HSP40539G | 05 | |
| CA | BLUE SHIELD INPATIENT | ZZZC1702Z | 01 |
| Other Name | Type Code |
|---|---|
| St. Helena Hospital-Clearlake | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972593788 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 21337 Bush St, Middletown, CA 95461 | 2005-10-24 |
| 1962492876 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 5290 State St, Kelseyville, CA 95451-9450 | 2005-10-24 |
| 1316937121 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 15230 Lakeshore Drive, Clearlake, CA 95422-6710 | 2005-10-24 |
| 1285054106 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 155 Solano St, Corning, CA 96021-3511 | 2014-04-17 |
| 1487897047 | Adventist Health Clearlake Hospital Inc. | General Acute Care Hospital | 15630 18th Ave, Clearlake, CA 95422 | 2009-04-13 |
| 1912092792 | Adventist Health Clearlake Hospital Inc. | Clinic/Center | 5125 Skyway, Paradise, CA 95969-5624 | 2006-10-04 |
| Street Address |
15630 18TH AVE |
| City | CLEARLAKE |
| State | CA |
| Zip Code | 95422-6710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927608 | Stephenie Hargrove | Nurse Practitioner | 15630 18th Ave, Clearlake, CA 95422-9336 | 2020-09-18 |
| 1740804368 | Matthew Jasun Lee | Dietitian, Registered | 15630 18th Ave, Clearlake, CA 95422-9336 | 2020-05-29 |
| 1326404948 | Bhaisaja PC | Anesthesiology | 15630 18th Ave, Clearlake, CA 95422-9336 | 2016-01-12 |
| 1811362585 | Jennifer A Dowalter Md A Professional Corporation | Internal Medicine | 15630 18th Ave, Clearlake, CA 95422-9336 | 2015-12-07 |
| 1609255660 | Amber Warner | Social Worker | 15630 18th Ave, Clearlake, CA 95422-9336 | 2015-05-23 |
| 1356649545 | Laurie K Halversen | Social Worker | 15630 18th Ave, Clearlake, CA 95422-9336 | 2011-03-11 |
| 1760614150 | Alliance Healthcare Services Inc | Clinic/Center | 15630 18th Ave, Clearlake, CA 95422 | 2009-08-18 |
| 1487897047 | Adventist Health Clearlake Hospital Inc. | General Acute Care Hospital | 15630 18th Ave, Clearlake, CA 95422 | 2009-04-13 |
| 1821237371 | California Em-i Medical Services | Physician Assistant | 15630 18th Ave, Clearlake, CA 95422-9336 | 2009-02-06 |
| 1023263399 | Konocti Emergency Physicians | Emergency Medicine | 15630 18th Ave, Clearlake, CA 95422-9336 | 2008-11-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831729201 | Richard Charles Hammond | Counselor | 7000 B South Center Drive, Clearlake, CA 95422 | 2020-01-24 |
| 1609416437 | Junirose Thom | Behavioral Analyst | 4456 Manzanita Avenue Suite 2, Clearlake, CA 95422 | 2020-01-09 |
| 1649781360 | Lake County Office of Education | Local Education Agency (LEA) | 3350 Acacia St, Clearlake, CA 95422 | 2017-10-20 |
| 1083091326 | Noelle Menesini | Physician Assistant | 15230 Lake Shore Drive, Clearlake, CA 95422 | 2015-05-06 |
| 1861820979 | Lake County Office of Education | Local Education Agency (LEA) | 6945 Old Highway 53, Clearlake, CA 95422 | 2013-10-29 |
| 1124469838 | Hassan Sheikh Moghaddas | Surgery | 15332 Lakeshore Dr Ste 101, Clearlake, CA 95422 | 2013-07-10 |
| 1366710279 | Nancy Bylund | Licensed Psychiatric Technician | 7000b South Center Drive, Clearlake, CA 95422 | 2011-12-06 |
| 1699060830 | Planned Parenthood Shasta Pacific | Clinic/Center | 1437 Olympic Drive, Cleaklake, CA 95422 | 2011-06-16 |
| 1164655247 | Hector Lara | Counselor | 14130 Lakeshore Dr., Clearlake, CA 95422 | 2009-08-24 |
| 1518197607 | Vishal V Desai | Pharmacist | 15025, Olympic Drive, Clearlake, CA 95422 | 2009-07-23 |
| Find all providers in zip 95422 | ||||
| Taxonomy Code | 282NC0060X |
| Grouping | Hospitals |
| Classification | General Acute Care Hospital |
| Specialization | Critical Access |
| Definition to come. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487897047 | Adventist Health Clearlake Hospital Inc. | General Acute Care Hospital | 15630 18th Ave, Clearlake, CA 95422 | 2009-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407208713 | Moheb Youssef,m.d.,inc | General Acute Care Hospital | 5730 Glen Oaks Dr, La Verne, CA 91750-1713 | 2016-07-11 |
| 1659720373 | Pavel S. Volkov, M.d. Inc. | General Acute Care Hospital | 2393 E Strathmore Pl, Fresno, CA 93730-9717 | 2016-06-03 |
| 1841647575 | Ma Corazon Sabado Domine-flores | General Acute Care Hospital | 13884 Euclid St Apt B01, Garden Grove, CA 92843-3401 | 2016-05-23 |
| 1215305404 | Karen Samartan | General Acute Care Hospital | 6361 Varsity Dr, Huntington Beach, CA 92647-6544 | 2015-09-04 |
| 1427486802 | Lake Arrowhead Physical Therapy | General Acute Care Hospital | 29099 Hospital Rd Suite 106, Lake Arrowhead, CA 92352-0070 | 2013-10-23 |
| 1841626587 | Adventist Health Clearlake Hospital, Inc | General Acute Care Hospital | 9430 Lake St, Lower Lake, CA 95457-8600 | 2013-09-25 |
| 1982948030 | Kern Medical Center | General Acute Care Hospital | 1420 H Street, Bakersfield, CA 93305 | 2012-11-15 |
| 1881960698 | Lisa M Bach Bohler | General Acute Care Hospital | 2202 N Magnolia Rd, Palm Springs, CA 92262-3652 | 2012-03-26 |
| 1750680914 | Cedars-sinai Medical Center | General Acute Care Hospital | 1650 Manning Ave, Los Angeles, CA 90024-5810 | 2011-03-26 |
| 1962705772 | Needles Hospital, Inc | General Acute Care Hospital | 1916 Desoto St, Needles, CA 92363-3023 | 2010-12-16 |
| 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.