ADVENTIST HEALTH CLEARLAKE HOSPITAL INC.
NPI 1124018031
General Acute Care Hospital - Critical Access in Clearlake, CA

Q: What is Adventist Health Clearlake Hospital Inc.'s specialty?

The primary specialty registered for this NPI is General Acute Care Hospital, specializing in Critical Access, with taxonomy code 282NC0060X.

Active since October 24, 2005CLIA 05D0611927 · Accreditation

15630 18TH AVE, CLEARLAKE, CA 95422(707) 994-6486(707) 995-3631 Get Directions Write a Review

NPPES record last updated: September 15, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 15, 2025, Jun 18, 2025, Dec 20, 2022 and 1 more (4 updates tracked since 2022).

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About Adventist Health Clearlake Hospital Inc. NPPES

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

ADVENTIST HEALTH CLEARLAKE HOSPITAL INC. (NPI 1124018031), doing business as Adventist Health Clear Lake, is a healthcare organization registered as a critical access in Clearlake, California and active in the NPI registry since October 2005. The organization holds an CLIA Accreditation certificate valid through January 2, 2027 and lists Parker J Pridgen, President, as its authorized official.

NPPES Registry Identity

NPI1124018031

Entity TypeOrganization

Primary Taxonomy282NC0060X

Legal Business NameADVENTIST HEALTH CLEARLAKE HOSPITAL INC.

Location Address15630 18TH AVEClearlake, CA 95422-6710

Mailing AddressPo Box 888837Los Angeles, CA 90088-8837

Phone(707) 994-6486

Fax(707) 995-3631

Organization SubpartNo

Authorized OfficialParker J PridgenPresident · (707) 467-5200

Enumeration DateOctober 24, 2005

Last NPPES UpdateSeptember 15, 20254 updates tracked since enumeration

NPPES CertifiedSeptember 15, 2025

✔ NPI 1124018031 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral Acute Care Hospital · Critical AccessHospitals

Taxonomy Code282NC0060X

License✔ Licensed in CA · 110000174

15630 18TH AVE, Clearlake, CA 95422

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Other Names 1

Doing Business AsAdventist Health Clear Lake

Other Identifiers 3

MedicaidHSP40539GCA

OtherZZZC1702ZCA · Blue Shield Inpatient

MedicaidZZR00539GCA

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 of Accreditation 05D0611927

Adventist Health Clear Lake · Clearlake, CA

Active · expires Jan 2, 2027

CLIA Number05D0611927

Laboratory TypeHospital

Certificate Effective DateJanuary 3, 2025

Certificate Expiration DateJanuary 2, 2027

Laboratory DirectorAnthony E. Victorio

Laboratory Phone(707) 995-5778

Laboratory LocationAdventist Health Clear Lake15630 18th Ave, Clearlake, CA 95422

CLIA data matches this NPI record on: Address Name

This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Other Providers at the Same Location NPPES 20

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

KONOCTI EMERGENCY PHYSICIANS

Emergency Medicine