NPIMap

Organization Active NPI

Sac Health System

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
National Provider Identifier
1013935915
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAC HEALTH SYSTEM
Practice address
1454 E 2ND St
San Bernardino, CA 92408-0118
Phone
(909) 382-7100
Fax
(909) 382-7136
NPI assigned
Jul 18, 2006
Last updated
Apr 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Authorized official

Name
Tasha Amick
Title
Dir. of Billing
Phone
(909) 382-7100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X CMM70708F CA
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X CMM70708F CA

Addresses

Primary practice location

1454 E 2ND St
San Bernardino, CA 92408-0118

Mailing address

1454 E 2ND St
San Bernardino, CA 92408-0118
Phone (909) 382-7100

Other identifiers 3

IdentifierTypeStateIssuer
EAP70708FOtherCAEAPC
ENVOY3000OtherCAENVOY SITE ID
CMM70708FMedicaidCA

Other names 1

  • SAC Norton Community Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040315000608 CA Part B Supplier - Clinic/Group Practice 4385533579 Receives reassigned benefits from 461 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indio, CA; Murrieta, CA; Rialto, CA; San Bernardino, CA
O20120629000147 CA Part A Provider - Federally Qualified Health Center (FQHC) 4385533579 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Bernardino, CA
O20121101000566 CA Part A Provider - Federally Qualified Health Center (FQHC) 4385533579 Practice locations: San Bernardino, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1013935915. Details of each certification follow.

Federally qualified health center certification: CCN 551156

Legal name
SAC HEALTH SYSTEM
Doing business as
SAC HEALTH SYSTEM FRAZEE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 29, 2012
Last certification
Jun 29, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 18, 1995 in CA
Enrollment address
488 S K St
San Bernardino, CA 92410-2641

Federally qualified health center certification: CCN 551175

Legal name
SAC HEALTH SYSTEM
Doing business as
SAC HEALTH SYSTEM NORTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 2012
Last certification
Nov 1, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 18, 1995 in CA
Enrollment address
1454 E 2ND St
San Bernardino, CA 92408-0118

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0910668Sac Health System1454 E 2ND Street, San Bernardino, CA 92408Provider-performed microscopyFeb 13, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Peter J Baker Individual Corporate Director Feb 22, 2022
Angela Teresi Individual W-2 Managing EmployeeCredentialing Supervisor Jun 29, 2015
Jason Lohr Individual Corporate OfficerCeo Dec 1, 2018
Corporate OfficerCeo/President Dec 1, 2018
Bonnie I CHI Lum Individual Corporate OfficerCmo Jul 1, 2018
Corporate Officer Jul 1, 2018
Pat Morris Individual Corporate Director Sep 24, 2019
Raul Castillo Individual Corporate DirectorBoard Member Jan 1, 2000
Corporate OfficerDirector Jun 1, 2000
Richard Henry Hart Individual Corporate OfficerBoard Member Jul 1, 2011
Corporate DirectorDirector Jun 1, 2011
Edith Ann Atkinson Individual Corporate DirectorBoard Member Jul 1, 2011
Corporate DirectorDirector Jul 1, 2011
Jordan Urban Individual Corporate OfficerCfo Dec 30, 2022
Maryellen R Westerberg Individual Corporate Officer Jul 1, 2018
Rodney Neal Individual Corporate OfficerBoard Member Jul 1, 2011
Corporate Director Sep 1, 2014
Jessica Garcia Individual Corporate Director Feb 22, 2022
Marilyn Hermann Individual Corporate DirectorBoard Member Jul 1, 2011
Ken Ramirez Individual Corporate Director Jan 26, 2021

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 84

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.

View all 84

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745193600000",
    "number": "1013935915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 E 2ND ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924080118",
            "telephone_number": "909-382-7100",
            "fax_number": "909-382-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1454 E 2ND ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924080118",
            "telephone_number": "909-382-7100",
            "fax_number": "909-382-7136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAC HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A",
        "authorized_official_last_name": "AMICK",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "DIR. OF BILLING",
        "authorized_official_telephone_number": "909-382-7100"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "CMM70708F",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "CMM70708F",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP70708F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ENVOY SITE ID",
            "identifier": "ENVOY3000",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70708F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAC Norton Community",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SAC Norton Community",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.