SHASTA LAKE FAMILY HEALTH & DENTAL CENTER
NPI 1013932797
Clinic/Center - Federally Qualified Health Center (FQHC) in Shasta Lake, CA
About Shasta Lake Family Health & Dental Center NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SHASTA LAKE FAMILY HEALTH & DENTAL CENTER (NPI 1013932797) is a healthcare organization registered as a federally qualified health center (fqhc) in Shasta Lake, California and active in the NPI registry since July 2006. The organization lists Jeffery Brandon Thornock, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 5
Other Names 1
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Shasta Lake Family Health & Dental Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by December 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
143Medicare enrollment records show 143 clinicians reassign Medicare billing to Shasta Lake Family Health & Dental Center, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 96 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 24
Nearest to this location (20)
See all 143Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Shasta Community Health Center's NPI number?
The NPI number for Shasta Community Health Center is 1013932797. It was assigned to this organization in the NPPES registry on July 13, 2006. The provider is doing business as Shasta Lake Family Health & Dental Center.
Where is Shasta Community Health Center located?
Shasta Community Health Center is located at 4215 Front St, Shasta Lake, CA 96019. The listed phone number is (530) 246-5896.
What is Shasta Community Health Center's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is Shasta Community Health Center enrolled in Medicare?
Yes. Shasta Community Health Center is registered in the Medicare PECOS enrollment system.
When is Shasta Community Health Center's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Shasta Community Health Center?
According to the CMS Revalidation Reassignment List (October 2026 release), 143 clinicians in 24 Medicare specialties reassign their Medicare billing to Shasta Community Health Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (46), Family Practice (44) and Dentist (8). Of these, 3 practice at this address and 96 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Shasta Community Health Center was last updated on October 16, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Shasta Lake Family Health & Dental Center · NPI 1013932797
Federally Qualified Health Center (FQHC) organization in Shasta Lake, California. Organization record, active in the CMS NPPES registry since July 13, 2006.
## Identity
- **NPI:** 1013932797 (Entity type: Organization)
- **Enumerated:** July 13, 2006
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Legal business name:** Shasta Community Health Center
- **Organization subpart:** Yes (part of Shasta Community Health Center)
- **Authorized official:** Jeffery Thornock, CEO
## Practice location
- **Address:** 4215 FRONT ST, Shasta Lake, CA 96019-9430
- **Phone:** (530) 246-5896 · **Fax:** (530) 241-7838
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** December 31, 2026 (Non-DME Part B, California, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 143 clinicians in 24 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (46), Family Practice (44), Dentist (8); 3 practice at this address and 96 within 10 miles; [full list](https://npiprofile.com/npi/1013932797/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 16, 2024
- **Other identifiers:** Other FHC70877F (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1013932797) · Data from the CMS NPPES public registry.