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MENDOCINO COAST CLINICS INC
NPI 1083783757
Clinic/Center - Federally Qualified Health Center (FQHC) in Fort Bragg, CA

Active since November 07, 2006
205 SOUTH STREET, FORT BRAGG, CA 95437(707) 964-1251(707) 961-2722 Get Directions Write a Review

NPPES record last updated: June 9, 2020. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 9, 2020, Oct 11, 2019 (2 updates tracked since 2019).

About Mendocino Coast Clinics Inc NPPES

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

MENDOCINO COAST CLINICS INC (NPI 1083783757) is a healthcare organization registered as a federally qualified health center (fqhc) in Fort Bragg, California and active in the NPI registry since November 2006. The organization lists Lucresha Renteria, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1083783757
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameMENDOCINO COAST CLINICS INC
Location Address205 SOUTH STREETFort Bragg, CA 95437-5540
Mailing Address205 South StreetFort Bragg, CA 95437-5540 · (707) 964-1251 · Fax (707) 961-2722
Phone(707) 964-1251
Fax(707) 961-2722
Organization SubpartNo
Authorized OfficialLucresha RenteriaExecutive Director · (707) 964-1251
Enumeration DateNovember 7, 2006
Last NPPES UpdateJune 9, 20202 updates tracked since enumeration
NPPES CertifiedJune 9, 2020
✔ NPI 1083783757 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
205 SOUTH STREET, Fort Bragg, CA 95437
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Other Identifiers 2

MedicaidFHC03967FCA
OtherZZZ15984ZCA · Medicare Part B Ptan

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)

Mendocino Coast Clinics Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 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.

StateEnrollment IDDue date
StateCaliforniaEnrollment IDO20050512001033Non-DME Part B · Clinic/Group PracticeDue dateOctober 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

33

Medicare enrollment records show 33 clinicians reassign Medicare billing to Mendocino Coast Clinics Inc, which bills Medicare for the services they deliver. Of these, 18 practice at this address and 25 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 15

Clinical Social Worker7
Nurse Practitioner6
Internal Medicine4
Family Practice3
Certified Nurse Midwife (CNM)2
Clinical Psychologist2
Chiropractic1
Emergency Medicine1
7 other specialties7

Nearest to this location (20)

See all 33
Cayo Alba, CNM, PMHNP-BC
Certified Nurse Midwife (CNM)
NPI 1164718334
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOS✔ Accepts MedicareSame address
Lisa Fredrickson, FNP
Nurse Practitioner
NPI 1932533924
205 SOUTH ST
Fort Bragg, CA 95437
(707) 961-1251
✔ PECOSSame address
Ann Gallo, LCSW
Clinical Social Worker
NPI 1891980561
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOS✔ Accepts MedicareSame address
Lawrence Goldyn, M.D.
Internal Medicine
NPI 1780605097
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOS✔ Accepts MedicareSame address
Linnea Matthews, FNP
Nurse Practitioner
NPI 1417174756
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOSSame address
John Remington, PSY.D.
Clinical Psychologist
NPI 1538231246
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOSSame address
Brent Wright, MD
Obstetrics/Gynecology
NPI 1275657231
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOSSame address
James Young, DC
Chiropractic
NPI 1942353875
205 SOUTH ST
Fort Bragg, CA 95437
(707) 961-4088
✔ Accepts MedicareSame address
Hilary Kaye, NP
Nurse Practitioner
NPI 1558166983
205 SOUTH ST
Fort Bragg, CA 95437
(707) 961-4088
✔ PECOS✔ Accepts MedicareSame address
Genevieve Banegas, LCSW, PPSC
Clinical Social Worker
NPI 1821340480
205 SOUTH ST
Fort Bragg, CA 95437
(707) 961-3492
✔ PECOS✔ Accepts MedicareSame address
Wade Gray, MD
Family Practice
NPI 1508861782
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOS✔ Accepts MedicareSame address
Thomas Knecht, MD, PHD
Endocrinology
NPI 1235371857
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOSSame address
Douglas Lister, DPM
Podiatry
NPI 1295958312
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOS✔ Accepts MedicareSame address
Muaj Lo, MD
Family Practice
NPI 1487644985
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOS✔ Accepts MedicareSame address
David Stein, LCSW
Clinical Social Worker
NPI 1104999606
205 SOUTH ST
Fort Bragg, CA 95437
(707) 961-4088
✔ PECOS✔ Accepts MedicareSame address
John Wallace, MD
Internal Medicine
NPI 1023079803
205 SOUTH ST
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOSSame address
Jenna Breton, NPF
Certified Nurse Midwife (CNM)
NPI 1427222538
855 SEQUOIA CIR
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOS✔ Accepts MedicareSame address
Kei Velazquez, CNM
Nurse Practitioner
NPI 1760581631
855 SEQUOIA CIR
Fort Bragg, CA 95437
(707) 964-1251
✔ PECOS✔ Accepts MedicareSame address
Jennifer Kreger, MD
Family Practice
NPI 1922005586
721-A RIVER DRIVE
Fort Bragg, CA 95437
(707) 961-4631
✔ PECOS0.1 mi
Kunal Goel
Internal Medicine
NPI 1619610714
700 RIVER DR
Fort Bragg, CA 95437
(707) 961-4631
✔ PECOS✔ Accepts Medicare0.2 mi
See all 33 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

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 for Provider-Performed Microscopy Procedures (PPMP) 05D0890246

Mendocino Coast Clinics · Fort Bragg, CA
Expired · Sep 9, 2026
CLIA Number05D0890246
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateSeptember 10, 2024
Certificate Expiration DateSeptember 9, 2026
Laboratory DirectorLawrence Goldyn
Laboratory Phone(707) 964-1251
Laboratory LocationMendocino Coast Clinics205 South St, Fort Bragg, CA 95437
CLIA data matches this NPI record on: Address Name Phone
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.

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 Mendocino Coast Clinics Inc's NPI number?

The NPI number for Mendocino Coast Clinics Inc is 1083783757. It was assigned to this organization in the NPPES registry on November 7, 2006.

Where is Mendocino Coast Clinics Inc located?

Mendocino Coast Clinics Inc is located at 205 South Street, Fort Bragg, CA 95437. The listed phone number is (707) 964-1251.

What is Mendocino Coast Clinics Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Is Mendocino Coast Clinics Inc enrolled in Medicare?

Yes. Mendocino Coast Clinics Inc is registered in the Medicare PECOS enrollment system.

When is Mendocino Coast Clinics Inc'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 October 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 Mendocino Coast Clinics Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 33 clinicians in 15 Medicare specialties reassign their Medicare billing to Mendocino Coast Clinics Inc. 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 Clinical Social Worker (7), Nurse Practitioner (6) and Internal Medicine (4). Of these, 18 practice at this address and 25 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 Mendocino Coast Clinics Inc was last updated on June 9, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.