MATHIESEN MEMORIAL HEALTH CLINIC
NPI 1255595484
Clinic/Center - Federally Qualified Health Center (FQHC) in Jamestown, CA
About Mathiesen Memorial Health Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MATHIESEN MEMORIAL HEALTH CLINIC (NPI 1255595484) is a healthcare organization registered as a federally qualified health center (fqhc) in Jamestown, California and active in the NPI registry since July 2008. The organization holds a CLIA Waiver certificate valid through July 2, 2028, maintains 3 additional practice locations, and lists Jacqueline Kiss, Credentialing, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Secondary Practice Locations 3
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mathiesen Memorial Health Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
17Medicare enrollment records show 17 clinicians reassign Medicare billing to Mathiesen Memorial Health Clinic, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 12 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 6
Clinicians, nearest first (17)
Colorado Springs, CO 80923
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 of Waiver 05D2346611
Mathiesen Memorial Health Clinic Vin 1f66f5dn3r0a01445 · Jamestown, CAFrequently 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 Mathiesen Memorial Health Clinic's NPI number?
The NPI number for Mathiesen Memorial Health Clinic is 1255595484. It was assigned to this organization in the NPPES registry on July 16, 2008.
Where is Mathiesen Memorial Health Clinic located?
Mathiesen Memorial Health Clinic is located at 18144 Seco St, Jamestown, CA 95327. The listed phone number is (209) 984-4820.
What is Mathiesen Memorial Health Clinic's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is Mathiesen Memorial Health Clinic enrolled in Medicare?
Yes. Mathiesen Memorial Health Clinic is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Mathiesen Memorial Health Clinic?
According to the CMS Revalidation Reassignment List (October 2026 release), 17 clinicians in 6 Medicare specialties reassign their Medicare billing to Mathiesen Memorial Health Clinic. 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 (9), Clinical Psychologist (2) and Clinical Social Worker (2). Of these, 5 practice at this address and 12 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Mathiesen Memorial Health Clinic hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2346611) is associated with this NPI, valid through July 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Mathiesen Memorial Health Clinic was last updated on July 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Mathiesen Memorial Health Clinic · NPI 1255595484
Federally Qualified Health Center (FQHC) organization in Jamestown, California. Organization record, active in the CMS NPPES registry since July 16, 2008.
## Identity
- **NPI:** 1255595484 (Entity type: Organization)
- **Enumerated:** July 16, 2008
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Organization subpart:** No
- **Authorized official:** Jacqueline Kiss, CREDENTIALING
## Practice location
- **Address:** 18144 SECO ST, Jamestown, CA 95327-9737
- **Phone:** (209) 984-4820 · **Fax:** (209) 984-4825
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 17 clinicians in 6 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (9), Clinical Psychologist (2), Clinical Social Worker (2); 5 practice at this address and 12 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 25, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1255595484) · Data from the CMS NPPES public registry.