| Kima-w Medical Center | |
|
535 Airport Rd Hoopa CA 95546-9615 | |
| (530) 625-4261 | |
| (530) 625-9308 |
| Full Name | Kima-w Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 535 Airport Rd, Hoopa, California |
| Authorized Official Name and Position | David Wickard (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5306254261 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kima-w Medical Center 535 Airport Rd Hoopa CA 95546-9615 Ph: (530) 625-4261 | Kima-w Medical Center 535 Airport Rd Hoopa CA 95546-9615 Ph: (530) 625-4261 |
| NPI Number | 1306904222 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 05/07/2026 |
| Certification Date | 05/07/2026 |
| Medicare PECOS PAC ID | 5496740698 |
|---|---|
| Medicare Enrollment ID | O20040416001480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306904222 | NPI | - | NPPES |
| PHE43666 | Other | CA | PHARMACY |
| PHE436660 | Other | CA | PHARMACY MEDICAID NUMBER |
| 0533922 | Other | CA | PHARMACY NABP |
| THP11573F | Medicaid | CA | |
| 05D0699458 | Other | CA | CLIA |
| EAP11573F | Other | CA | EAPC |
| 005540 | Other | CA | BC COUNTY MEDICAID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | EXEMPT INDIAN TRIBE (California) | Primary |
| Provider Name | Timothy C Paik Nicely |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760489389 PECOS PAC ID: 6800797234 Enrollment ID: I20040117000200 |
| Provider Name | Michael D Fratkin |
|---|---|
| Provider Type | Practitioner - Hospice/palliative Care |
| Provider Identifiers | NPI Number: 1508892738 PECOS PAC ID: 7113981523 Enrollment ID: I20041116000465 |
| Provider Name | Jennifer a Jackson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1053579284 PECOS PAC ID: 7012964042 Enrollment ID: I20050401000578 |
| Provider Name | Eva Marie Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982773099 PECOS PAC ID: 9931194131 Enrollment ID: I20050610000602 |
| Provider Name | Susan N Walsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306915418 PECOS PAC ID: 6800820234 Enrollment ID: I20050923000961 |
| Provider Name | May C Hong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811933690 PECOS PAC ID: 4587642657 Enrollment ID: I20080125000210 |
| Provider Name | Leslie J Ballard |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1922069335 PECOS PAC ID: 5890693691 Enrollment ID: I20080529000779 |
| Provider Name | Antoinette P Martinez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891855052 PECOS PAC ID: 5698827400 Enrollment ID: I20090708000644 |
| Provider Name | Victor Gregory Krall |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1386746477 PECOS PAC ID: 9638339401 Enrollment ID: I20120402000483 |
| Provider Name | Sawar C Young |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093924052 PECOS PAC ID: 4688701675 Enrollment ID: I20130628000083 |
| Provider Name | Steven Sust |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407174477 PECOS PAC ID: 7416274543 Enrollment ID: I20150328000062 |
| Provider Name | Christopher Voss |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1942475538 PECOS PAC ID: 9739358698 Enrollment ID: I20150911000830 |
| Provider Name | James J Matsuda |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720066061 PECOS PAC ID: 8325275001 Enrollment ID: I20180919002571 |
| Provider Name | Mark Rader |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1396734950 PECOS PAC ID: 1254223720 Enrollment ID: I20200323000266 |
| Provider Name | Jeanne Diane Kimura |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1205139268 PECOS PAC ID: 5890175988 Enrollment ID: I20220707000879 |
| Provider Name | Vanessa Casey Akines |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790417434 PECOS PAC ID: 9830575091 Enrollment ID: I20220926003379 |
| Provider Name | Troy Bassiri |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316475643 PECOS PAC ID: 3870861255 Enrollment ID: I20230925002432 |
| Provider Name | Mark Y Liu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710967914 PECOS PAC ID: 8325041403 Enrollment ID: I20240213004404 |
| Provider Name | Claudia Collins |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780112094 PECOS PAC ID: 6002184397 Enrollment ID: I20240215001846 |
| Provider Name | Mark S Simpson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518952662 PECOS PAC ID: 6709901044 Enrollment ID: I20240429003384 |
| Provider Name | Jonathan David Kawulok Updike |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861995649 PECOS PAC ID: 0648718130 Enrollment ID: I20240815000351 |
| Provider Name | Landon Whittington |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295302891 PECOS PAC ID: 8729448048 Enrollment ID: I20241030000872 |
| Provider Name | Maizal Cuauhtemoc Rivera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841622305 PECOS PAC ID: 4981838802 Enrollment ID: I20250318001583 |
| Provider Name | Kevin Foley |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1528391380 PECOS PAC ID: 0749702587 Enrollment ID: I20250320003202 |
| Provider Name | Jill Marie Buller |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194302851 PECOS PAC ID: 3173965324 Enrollment ID: I20260130000120 |
| Provider Name | John Alexander Israel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457429722 PECOS PAC ID: 1658401104 Enrollment ID: I20260324003625 |
| Provider Name | Charles Peter Di Leonardo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1356095871 PECOS PAC ID: 9830576123 Enrollment ID: I20260420003635 |
| Provider Name | Jessica Dawn Bradford |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962414599 PECOS PAC ID: 3779893185 Enrollment ID: I20260424001905 |
| Provider Name | Michael Anthony Rodriguez |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1093976185 PECOS PAC ID: 2668941311 Enrollment ID: I20260512002856 |
| Provider Name | Samara Emilia Acosta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205553112 PECOS PAC ID: 6305217092 Enrollment ID: I20260522000945 |
| Provider Name | Brenda Kay Mack |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1447371075 PECOS PAC ID: 9739650656 Enrollment ID: I20260602001109 |
Kimaw Medical Center Pharmacy Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 535 Airport Rd Ste 104, Hoopa, CA 95546 Phone: 530-625-4585 Fax: 530-625-4312 |
K'ima: W Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1200 Airportroad, Hoopa, CA 95546 Phone: 530-625-4261 Fax: 530-625-9308 |
Kima-w Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 535 Airport Rd, Hoopa, CA 95546 Phone: 530-625-4261 Fax: 530-625-9308 |