ADVENTIST HEALTH CLEARLAKE HOSPITAL INC – NPI #1477104099
Clinic/Center

ADVENTIST HEALTH CLEARLAKE HOSPITAL INC is an AHC clinic located in CLEARLAKE, CA. NPPES has assigned the NPI number 1477104099 to ADVENTIST HEALTH CLEARLAKE HOSPITAL INC on September 25, 2019. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QR1300X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Rural Health

The NPI profile was last updated on Sep 15, 2025. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ADVENTIST HEALTH CLEARLAKE HOSPITAL INC below.

NPI Profile for
ADVENTIST HEALTH CLEARLAKE HOSPITAL INC

NPI Number
1477104099
Enumeration Date

(more than 6 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
ADVENTIST HEALTH CLEARLAKE HOSPITAL INC
Primary location
15322 LAKESHORE DRIVE
SUITE 101, 102 AND 201
CLEARLAKE, CA 95422
Phone: (707) 461-7986 Fax:
Mailing address
PO BOX 888837
LOS ANGELES, CA 90088-8837
Phone: Fax:
Organization Subpart
No
Authorized Official
PARKER PRIDGEN
PRESIDENT
Phone: (707) 467-5200
Updated
Certification Date
Sep 15, 2025

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QR1300X
- Clinic/Center / Rural Health (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.

Endpoint

Health Information Exchange (HEI)

HEI is the mobilization of health care information electronically across organizations within a region, community or hospital system. Endpoints provide a simple and secure way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet such as primary care physicians, specialists, hospitals, labs, etc.

Endpoint
https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service
Endpoint type
CONNECT URL
Endpoint Description
2.16.840.1.113883.3.2019.3
Content Type
Affiliation
Y
Endpoint Location
15322 LAKESHORE DRIVE,
CLEARLAKE, CA 77025-1669