| Potawot Health Village | |
|
1600 Weeot Way Arcata CA 95521-4734 | |
| (707) 825-5000 | |
| (707) 825-6747 |
| Full Name | Potawot Health Village |
|---|---|
| Speciality | Clinic/Center |
| Location | 1600 Weeot Way, Arcata, California |
| Authorized Official Name and Position | Cecil Paul Wilson (CFO) |
| Authorized Official Contact | 7078254065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Potawot Health Village 1600 Weeot Way Arcata CA 95521-4734 Ph: (707) 825-5000 | Potawot Health Village 1600 Weeot Way Arcata CA 95521-4734 Ph: (707) 825-5000 |
| NPI Number | 1497751572 |
|---|---|
| Provider Enumeration Date | 06/23/2005 |
| Last Update Date | 08/24/2022 |
| Certification Date | 08/24/2022 |
| Medicare PECOS PAC ID | 9830085075 |
|---|---|
| Medicare Enrollment ID | O20040225000459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497751572 | NPI | - | NPPES |
| Provider Name | Timothy C Paik Nicely |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760489389 PECOS PAC ID: 6800797234 Enrollment ID: I20040117000200 |
| Provider Name | Gurudarshan S Khalsa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356409973 PECOS PAC ID: 8325939085 Enrollment ID: I20071015000343 |
| Provider Name | Antoinette P Martinez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1891855052 PECOS PAC ID: 5698827400 Enrollment ID: I20090708000644 |
| Provider Name | Jeffrey T Ribordy |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1467458380 PECOS PAC ID: 0244424356 Enrollment ID: I20101103000154 |
| Provider Name | Kathleen M Cassel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962400051 PECOS PAC ID: 6901074442 Enrollment ID: I20110727000489 |
| Provider Name | Tin C Botzler |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1831491695 PECOS PAC ID: 0143495499 Enrollment ID: I20111214000887 |
| Provider Name | Danielle Luke Lefever |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1609183144 PECOS PAC ID: 8527219971 Enrollment ID: I20121112000091 |
| Provider Name | Terry W Raymer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902804099 PECOS PAC ID: 0648270975 Enrollment ID: I20140312000902 |
| Provider Name | Joseph T Breen |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1467574616 PECOS PAC ID: 2062302342 Enrollment ID: I20140409000481 |
| Provider Name | Allegra Stroup |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982018966 PECOS PAC ID: 2365764545 Enrollment ID: I20141124002380 |
| Provider Name | Hugh D Kent |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467740662 PECOS PAC ID: 9638302359 Enrollment ID: I20141231001974 |
| Provider Name | Steven Sust |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1407174477 PECOS PAC ID: 7416274543 Enrollment ID: I20150328000062 |
| Provider Name | Sarah D Thibault |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134452980 PECOS PAC ID: 8628383361 Enrollment ID: I20150810003211 |
| Provider Name | Grace Mcatasney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457804619 PECOS PAC ID: 5294010955 Enrollment ID: I20170320001056 |
| Provider Name | James Michael Riley |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1063542454 PECOS PAC ID: 2668495474 Enrollment ID: I20180611001509 |
| Provider Name | Carol Griffin |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1912269408 PECOS PAC ID: 0345499901 Enrollment ID: I20180621002739 |
| Provider Name | James J Matsuda |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1720066061 PECOS PAC ID: 8325275001 Enrollment ID: I20180919002571 |
| Provider Name | Michael F Mangahas |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689053738 PECOS PAC ID: 3678808953 Enrollment ID: I20190709001291 |
| Provider Name | Christopher Myers |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1336554302 PECOS PAC ID: 8123398427 Enrollment ID: I20191014002749 |
| Provider Name | Haley April Davies |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942858790 PECOS PAC ID: 0244657195 Enrollment ID: I20200824003498 |
| Provider Name | James Earl Holland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558510743 PECOS PAC ID: 5092057430 Enrollment ID: I20201009001993 |
| Provider Name | Dennis J Hernandez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467120931 PECOS PAC ID: 6103214507 Enrollment ID: I20211103001730 |
| Provider Name | Elizabeth Eleni Perry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669035523 PECOS PAC ID: 1355727496 Enrollment ID: I20220927003653 |
| Provider Name | Kenyetta Gordon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013101161 PECOS PAC ID: 3870786676 Enrollment ID: I20220928000794 |
| Provider Name | Wilmer Hechanova |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1518944578 PECOS PAC ID: 5597141937 Enrollment ID: I20221007001842 |
| Provider Name | Adrienne Wells |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1629173059 PECOS PAC ID: 6709079015 Enrollment ID: I20221014001976 |
| Provider Name | Kathryn Louise Biesanz |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801533658 PECOS PAC ID: 3173999075 Enrollment ID: I20221018001766 |
| Provider Name | Christina Dawn Casarez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548731094 PECOS PAC ID: 5597131425 Enrollment ID: I20221018003009 |
| Provider Name | Karthikeyan Viswanathan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396128336 PECOS PAC ID: 6103251442 Enrollment ID: I20230123001402 |
| Provider Name | Matthew John Tiss |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1427712736 PECOS PAC ID: 1951796903 Enrollment ID: I20230719000626 |
| Provider Name | Ryan Wayne Pate |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235633116 PECOS PAC ID: 6406103795 Enrollment ID: I20230801003628 |
| Provider Name | Madison Macgregor |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1902581846 PECOS PAC ID: 7618339268 Enrollment ID: I20230814001305 |
| Provider Name | Robert A Jason |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700260015 PECOS PAC ID: 7012253495 Enrollment ID: I20231219001885 |
| Provider Name | Lana Ann Dreyfuss |
|---|---|
| Provider Type | Practitioner - Other (non-physician) |
| Provider Identifiers | NPI Number: 1679914428 PECOS PAC ID: 3375996903 Enrollment ID: I20240130002351 |
| Provider Name | Marie Isabel Fazzone |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1992026876 PECOS PAC ID: 5294188850 Enrollment ID: I20240130003171 |
Odyssey Counseling Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 739 10th St, Arcata, CA 95521 Phone: 707-719-9194 | |
Multiplicity Therapeutic Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 875 Crescent Way, Arcata, CA 95521 Phone: 707-822-1136 Fax: 707-633-1777 | |
Daybreak Behavioral Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 791 8th St Ste S, Arcata, CA 95521 Phone: 707-834-2621 | |
Openmind Connections Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 311 Lupin Dr, Arcata, CA 95521 Phone: 707-498-5799 | |
Eva York Licensed Clinical Social Worker Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 854 10th St, Arcata, CA 95521 Phone: 707-298-0959 | |
Trillium Charter School Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1464 Spear Ave, Arcata, CA 95521 Phone: 707-822-4721 Fax: 707-822-7054 | |
Humboldt Family Service Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 801 Crescent Way Ste 3, Arcata, CA 95521 Phone: 707-496-7351 |