| Lake County Tribal Health Consortium Inc. | |
|
925 Bevins Ct Lakeport CA 95453-9754 | |
| (707) 263-8382 | |
| (707) 263-0329 |
| Full Name | Lake County Tribal Health Consortium Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 925 Bevins Ct, Lakeport, California |
| Authorized Official Name and Position | Ernesto Padilla (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7072638382 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake County Tribal Health Consortium Inc. 925 Bevins Ct Lakeport CA 95453-9754 Ph: (707) 263-8382 | Lake County Tribal Health Consortium Inc. 925 Bevins Ct Lakeport CA 95453-9754 Ph: (707) 263-8382 |
| NPI Number | 1881697381 |
|---|---|
| Provider Enumeration Date | 05/27/2005 |
| Last Update Date | 11/16/2011 |
| Medicare PECOS PAC ID | 8729975545 |
|---|---|
| Medicare Enrollment ID | O20040304000323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881697381 | NPI | - | NPPES |
| THP70611F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 110000289 (California) | Primary |
| Provider Name | Terri L Turner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366522831 PECOS PAC ID: 9830188671 Enrollment ID: I20040507000904 |
| Provider Name | Francisco Tejeda |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1407940075 PECOS PAC ID: 1759343080 Enrollment ID: I20041029000420 |
| Provider Name | Andre P Lallande |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053471045 PECOS PAC ID: 4385680545 Enrollment ID: I20050628001395 |
| Provider Name | Javier Arroyo |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1821183732 PECOS PAC ID: 0941226252 Enrollment ID: I20051017000425 |
| Provider Name | Ronald J Botelho |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1235199373 PECOS PAC ID: 4981702263 Enrollment ID: I20090129000268 |
| Provider Name | Joan Devito |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1962549469 PECOS PAC ID: 5597803973 Enrollment ID: I20091104000406 |
| Provider Name | Eric E Kim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578660916 PECOS PAC ID: 4486793551 Enrollment ID: I20091202000616 |
| Provider Name | Diane E Bajada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932354321 PECOS PAC ID: 7810032141 Enrollment ID: I20100310000947 |
| Provider Name | Marlene Q Quilala |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1346308855 PECOS PAC ID: 6103951421 Enrollment ID: I20100311000811 |
| Provider Name | Daniel G Lewis |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1457390155 PECOS PAC ID: 3072553676 Enrollment ID: I20100324000664 |
| Provider Name | Lorena A Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942558721 PECOS PAC ID: 0042460230 Enrollment ID: I20121024000623 |
| Provider Name | Susan R Gamble |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790950079 PECOS PAC ID: 3779752332 Enrollment ID: I20130115000262 |
| Provider Name | Harry D Goldwasser |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255370680 PECOS PAC ID: 7315901733 Enrollment ID: I20150716001424 |
| Provider Name | Derrick J Barnes |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336236488 PECOS PAC ID: 5294802872 Enrollment ID: I20150717002250 |
| Provider Name | Angelo J Chavez Guerrero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235465774 PECOS PAC ID: 9537296132 Enrollment ID: I20160225001197 |
| Provider Name | Sliman Costa Tannous |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114466521 PECOS PAC ID: 6901183078 Enrollment ID: I20170428000472 |
| Provider Name | Chalice Ann Addis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306359146 PECOS PAC ID: 8527325695 Enrollment ID: I20171127003137 |
| Provider Name | Louise Loe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669924171 PECOS PAC ID: 2163780305 Enrollment ID: I20171218001953 |
| Provider Name | Rebecca K Cross |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780048132 PECOS PAC ID: 4082975602 Enrollment ID: I20180222001956 |
| Provider Name | Angelo J Alfano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023503307 PECOS PAC ID: 9931446994 Enrollment ID: I20190129001922 |
| Provider Name | Gemalli Austin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1407283419 PECOS PAC ID: 0648513440 Enrollment ID: I20190518000101 |
| Provider Name | Charissa Barsos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215309398 PECOS PAC ID: 4880996875 Enrollment ID: I20191008000526 |
| Provider Name | Dawn Marie Pavli |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1649896549 PECOS PAC ID: 9830512680 Enrollment ID: I20200713000561 |
| Provider Name | Siamak Sahand |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1609479567 PECOS PAC ID: 2163835927 Enrollment ID: I20210115001510 |
| Provider Name | Anna Chacon |
|---|---|
| Provider Type | Practitioner - Dermatology |
| Provider Identifiers | NPI Number: 1073950689 PECOS PAC ID: 8527207919 Enrollment ID: I20210611002404 |
| Provider Name | Stephenie L Hargrove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053927608 PECOS PAC ID: 6305244369 Enrollment ID: I20211006001829 |
| Provider Name | Kenneth Ian Robbins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1588778583 PECOS PAC ID: 1759291511 Enrollment ID: I20211018002698 |
| Provider Name | David Golergant |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1528723459 PECOS PAC ID: 2365834876 Enrollment ID: I20220113000220 |
| Provider Name | Amy Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1467129767 PECOS PAC ID: 8628462280 Enrollment ID: I20220223002993 |
| Provider Name | Melissa Flores |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376925271 PECOS PAC ID: 1254707607 Enrollment ID: I20221026001816 |
| Provider Name | Gregory Arkady Avetisov |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1679917280 PECOS PAC ID: 9335470400 Enrollment ID: I20240716004349 |
| Provider Name | Yolanda Sorto Castanon |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1205069069 PECOS PAC ID: 0446797732 Enrollment ID: I20240805001520 |
| Provider Name | Calai S Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275117079 PECOS PAC ID: 5698212900 Enrollment ID: I20240805002174 |
| Provider Name | Deborah Suzanne Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649333444 PECOS PAC ID: 9638617533 Enrollment ID: I20240809001643 |
| Provider Name | Jennifer Sue Nauert |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437652385 PECOS PAC ID: 7012455967 Enrollment ID: I20240809003956 |
| Provider Name | Gema R Prieto |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1649564659 PECOS PAC ID: 1456899236 Enrollment ID: I20240812001318 |
| Provider Name | Theb Manivanh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649459835 PECOS PAC ID: 9537607262 Enrollment ID: I20240813003078 |
| Provider Name | Stacey Cranfill |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1841747136 PECOS PAC ID: 5698213049 Enrollment ID: I20240815003206 |
| Provider Name | Heather Anne Weller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508624297 PECOS PAC ID: 3072053149 Enrollment ID: I20240904004222 |
| Provider Name | Brooke H Brody |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245613819 PECOS PAC ID: 4486194404 Enrollment ID: I20240905001103 |
| Provider Name | Julie N Pennington |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1730415019 PECOS PAC ID: 3870034093 Enrollment ID: I20240916001162 |
| Provider Name | Suzanne Moineau |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1417194960 PECOS PAC ID: 7113468364 Enrollment ID: I20240916002212 |
| Provider Name | Alireza R Sadre-nassiri |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1740544303 PECOS PAC ID: 4981145596 Enrollment ID: I20240924000396 |
| Provider Name | Marlin Noelia Duran |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1144839853 PECOS PAC ID: 1850822859 Enrollment ID: I20241001004012 |
| Provider Name | Florencia Karina Miranda Chumpitaz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356121404 PECOS PAC ID: 0345771291 Enrollment ID: I20241002001287 |
| Provider Name | Angela Marie Knight |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1801939053 PECOS PAC ID: 0749711653 Enrollment ID: I20241002003767 |
| Provider Name | Liliana Caicedo |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1508140591 PECOS PAC ID: 5092246769 Enrollment ID: I20241004002315 |
| Provider Name | Emily Tang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497141832 PECOS PAC ID: 4385175074 Enrollment ID: I20241004003155 |
| Provider Name | Jai Lee |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1164497319 PECOS PAC ID: 2163567611 Enrollment ID: I20241008002029 |
| Provider Name | Steve P Murphy |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1346435872 PECOS PAC ID: 9133367220 Enrollment ID: I20241009000614 |
| Provider Name | Sunny H Park |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1568878478 PECOS PAC ID: 4486975059 Enrollment ID: I20241021003054 |
| Provider Name | Gholamreza Rezvani |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1437813029 PECOS PAC ID: 5890229140 Enrollment ID: I20241111000178 |
| Provider Name | Eliezer N Melendez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518926393 PECOS PAC ID: 5698735496 Enrollment ID: I20241114004359 |
| Provider Name | Lynnis L Mairena |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1558872846 PECOS PAC ID: 8729512256 Enrollment ID: I20241120004190 |
| Provider Name | Crystal N Factor |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1992138614 PECOS PAC ID: 0244767275 Enrollment ID: I20250102001924 |
Sutter Lakeside Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5176 Hill Rd E, Lakeport, CA 95453 Phone: 707-262-5001 Fax: 707-262-5006 | |
Sutter Lakeside Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5176 Hill Rd E, Lakeport, CA 95453 Phone: 707-262-5000 Fax: 707-262-5005 | |
Adventist Health Physicians Network Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 801 11th St, Lakeport, CA 95453 Phone: 707-263-3746 | |
Lake County Tribal Health Consortium, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 359 Lakeport Blvd, Lakeport, CA 95453 Phone: 707-533-2700 Fax: 707-263-5400 | |
Northern California Medical Assoc Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5108 Hill Rd E, Lakeport, CA 95453 Phone: 707-262-1840 Fax: 707-262-5844 | |
Sutter Bay Hospitals Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5196 Hill Rd E, Suite 300, Lakeport, CA 95453 Phone: 707-263-6885 Fax: 707-263-6624 | |
Sutter Lakeside Hospital Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5176 Hill Rd E, Lakeport, CA 95453 Phone: 707-262-5001 Fax: 707-262-5513 |