NPIMap

Organization Active NPI

Soledad Community Health Care District

Doing business as Soledad Medical Clinic

  • Rural Health Clinic/Center
  • Soledad, CA
National Provider Identifier
1003822453
Registry record updated Jun 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
070000327 Issued in CA
Legal business name
SOLEDAD COMMUNITY HEALTH CARE DISTRICT
Doing business as
Soledad Medical Clinic
Practice address
600 Main St
Soledad, CA 93960-2533
Phone
(831) 678-2462
Fax
(831) 678-1539
NPI assigned
Jul 31, 2006
Last updated
Jun 28, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
SOLEDAD COMMUNITY HEALTH CARE DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ida Lopez Chan
Title
Chief Executive Officer
Phone
(831) 678-2462

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 070000327 CA Primary

Addresses

Primary practice location

600 Main St
Soledad, CA 93960-2533

Mailing address

612 Main St
Soledad, CA 93960-2533
Phone (831) 678-2462

Other identifiers 1

IdentifierTypeStateIssuer
RHM53997FMedicaidCA

Other names 1

  • Soledad Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090729000329 CA Part B Supplier - Clinic/Group Practice 4385635085 Receives reassigned benefits from 8 practitioners
Practice locations: Soledad, CA
O20101111000316 CA Part A Provider - Rural Health Clinic 4385635085 Practice locations: Soledad, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003822453. Details of each certification follow.

Rural health clinic certification: CCN 553938

Legal name
SOLEDAD COMMUNITY HEALTH CARE DISTRICT
Doing business as
SOLEDAD MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2001
Last certification
Nov 5, 2018
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Mar 7, 1949 in CA
Enrollment address
600 Main St
Soledad, CA 93960-2533

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Soledad Community Health Care District

Locations

600 Main St
Soledad, CA 93960
Phone (831) 678-2665

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jaime Giron Individual Corporate Director Jan 18, 1995
Ida Chan Individual Corporate OfficerCeo Aug 3, 2020 100%
W-2 Managing EmployeeCeo Aug 3, 2020 100%
Soledad Community Health Care District Organization, Soledad, CA Operational/Managerial Control Jan 18, 1995 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624838400000",
    "number": "1003822453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 MAIN ST",
            "city": "SOLEDAD",
            "state": "CA",
            "postal_code": "939602533",
            "telephone_number": "831-678-2462",
            "fax_number": "831-678-1539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MAIN ST",
            "city": "SOLEDAD",
            "state": "CA",
            "postal_code": "939602533",
            "telephone_number": "831-678-2462",
            "fax_number": "831-678-1539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOLEDAD COMMUNITY HEALTH CARE DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOLEDAD COMMUNITY HEALTH CARE DISTRICT",
        "enumeration_date": "2006-07-31",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "IDA",
        "authorized_official_middle_name": "LOPEZ",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "831-678-2462"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "070000327",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RHM53997F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Soledad Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Soledad, CA

Sources for this page

Verify at the official NPI Registry.