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ST JOSEPH HERITAGE HEALTHCARE
NPI 1053617076
Family Medicine in Santa Rosa, CA

Active since February 09, 2011CLIA Certified · 2 labs
4750 HOEN AVE, SANTA ROSA, CA 95405(707) 542-1611(707) 542-9958 Get Directions Write a Review

NPPES record last updated: February 9, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About St Joseph Heritage Healthcare NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST JOSEPH HERITAGE HEALTHCARE (NPI 1053617076) is a healthcare organization registered as a family medicine in Santa Rosa, California and active in the NPI registry since February 2011. The organization holds 2 active CLIA laboratory certificates and lists John Bennett, Chief Operating Officer, as its authorized official.

NPPES Registry Identity

NPI1053617076
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameST JUDE HOSPITAL YORBA LINDA
Location Address4750 HOEN AVESanta Rosa, CA 95405-7833
Mailing Address279 Imperial Hwy, Suite 730Fullerton, CA 92835-1041 · (714) 449-4841 · Fax (714) 449-4956
Phone(707) 542-1611
Fax(707) 542-9958
Organization SubpartNo
Authorized OfficialJohn BennettChief Operating Officer · (714) 449-4800
Enumeration DateFebruary 9, 2011
✔ NPI 1053617076 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
4750 HOEN AVE, Santa Rosa, CA 95405
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Other Names 1

Doing Business AsSt Joseph Heritage Healthcare

Other Identifiers 1

Medicare PINBH969CA

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2008948

St Jude Hospital Yorba Linda Dba Providence Med Fdn, Montgomery Primary Care · Santa Rosa, CA
Active · expires Jun 21, 2028
CLIA Number05D2008948
Laboratory TypePhysician Office
Certificate Effective DateJune 22, 2026
Certificate Expiration DateJune 21, 2028
Laboratory DirectorLawrence R. Cooper
Laboratory Phone(707) 890-4102
Laboratory LocationSt Jude Hospital Yorba Linda Dba Providence Med Fdn, Montgomery Primary Care1162 Montgomery Drive, 2nd Floor, Santa Rosa, CA 95405
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D2130202

St Joseph Heritage Healthcare · Santa Rosa, CA
Active · expires May 2, 2027
CLIA Number05D2130202
Laboratory TypePhysician Office
Certificate Effective DateMay 3, 2025
Certificate Expiration DateMay 2, 2027
Laboratory DirectorAmy E. Shaw
Laboratory Phone(707) 525-4078
Laboratory LocationSt Joseph Heritage Healthcare121 Sotoyome St Ste 203, Santa Rosa, CA 95405
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SUTTER MEDICAL GROUP OF THE REDWOODS
Family Medicine
4750 HOEN AVE
SANTA ROSA, CA 95405
Sonoma County (707) 523-2666
ELLEN M ROCHE F.N.P.
Nurse Practitioner (Family)
4750 HOEN AVE, SUITE B
SANTA ROSA, CA 95405
Sonoma County (707) 542-1611
DR. CYNTHIA MORRIS M.D.
Family Medicine
4750 HOEN AVE
SANTA ROSA, CA 95405
Sonoma County (707) 542-1611
DR. HERBERT DEAN BROSBE M.D.
Family Medicine
4750 HOEN AVE
SANTA ROSA, CA 95405
Sonoma County (707) 542-1611

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 St Jude Hospital Yorba Linda's NPI number?

The NPI number for St Jude Hospital Yorba Linda is 1053617076. It was assigned to this organization in the NPPES registry on February 9, 2011. The provider is doing business as St Joseph Heritage Healthcare.

Where is St Jude Hospital Yorba Linda located?

St Jude Hospital Yorba Linda is located at 4750 Hoen Ave, Santa Rosa, CA 95405. The listed phone number is (707) 542-1611.

What is St Jude Hospital Yorba Linda's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does St Jude Hospital Yorba Linda hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for St Jude Hospital Yorba Linda was last updated on February 9, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 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.