ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC
NPI 1194189654
Clinic/Center - Rural Health in Fortuna, CA
About St. Joseph Health Northern California, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ST. JOSEPH HEALTH NORTHERN CALIFORNIA, LLC (NPI 1194189654), doing business as Providence Family Practice, is a healthcare organization registered as a rural health in Fortuna, California and active in the NPI registry since April 2016. The organization lists Donald Wayne Anderson, Assistant Secretary Of Enrollments, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
St. Joseph Health Northern California, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
32Medicare enrollment records show 32 clinicians reassign Medicare billing to St. Joseph Health Northern California, LLC, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 4 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 12
Nearest to this location (20)
See all 32Source: 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 St. Joseph Health Northern California, LLC's NPI number?
The NPI number for St. Joseph Health Northern California, LLC is 1194189654. It was assigned to this organization in the NPPES registry on April 11, 2016. The provider is doing business as Providence Family Practice.
Where is St. Joseph Health Northern California, LLC located?
St. Joseph Health Northern California, LLC is located at 3302 Renner Dr, Fortuna, CA 95540. The listed phone number is (707) 725-3318.
What is St. Joseph Health Northern California, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is St. Joseph Health Northern California, LLC enrolled in Medicare?
Yes. St. Joseph Health Northern California, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through St. Joseph Health Northern California, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 32 clinicians in 12 Medicare specialties reassign their Medicare billing to St. Joseph Health Northern California, LLC. 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 Cardiovascular Disease (Cardiology) (7), Certified Registered Nurse Anesthetist (CRNA) (6) and Internal Medicine (5). Of these, 3 practice at this address and 4 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 St. Joseph Health Northern California, LLC was last updated on May 7, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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.
# St. Joseph Health Northern California, Llc · NPI 1194189654
Rural Health organization in Fortuna, California. Organization record, active in the CMS NPPES registry since April 11, 2016.
## Identity
- **NPI:** 1194189654 (Entity type: Organization)
- **Enumerated:** April 11, 2016
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Also known as:** PROVIDENCE FAMILY PRACTICE (Doing Business As)
- **Organization subpart:** Yes (part of St. Joseph Health)
- **Authorized official:** Donald Anderson, ASSISTANT SECRETARY OF ENROLLMENTS
## Practice location
- **Address:** 3302 RENNER DR, Fortuna, CA 95540
- **Phone:** (707) 725-3318
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 32 clinicians in 12 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Cardiovascular Disease (Cardiology) (7), Certified Registered Nurse Anesthetist (CRNA) (6), Internal Medicine (5); 3 practice at this address and 4 within 10 miles; [full list](https://npiprofile.com/npi/1194189654/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 7, 2025
- **Other identifiers:** Medicaid 1194189654 (CA)
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Source: [NPI Profile](https://npiprofile.com/npi/1194189654) · Data from the CMS NPPES public registry.