NPIMap

Organization Active NPI

Bay Area Community Health

Doing business as Mowry I

  • Federally Qualified Health Center (FQHC)
  • Fremont, CA
National Provider Identifier
1033296272
Registry record updated Apr 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BAY AREA COMMUNITY HEALTH
Doing business as
Mowry I
Practice address
2299 Mowry Ave Ste 3B
Fremont, CA 94538-1621
Phone
(510) 770-8040
Fax
(510) 623-8926
NPI assigned
Nov 1, 2006
Last updated
Apr 1, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BAY AREA COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2022

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

Authorized official

Name
Dr. Zettie D Page III, MD, PH.D, MBA, MSW,
Title
Ceo
Phone
(510) 252-6811

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

2299 Mowry Ave Ste 3B
Fremont, CA 94538-1621

Mailing address

40910 Fremont Blvd
Fremont, CA 94538-4375
Phone (510) 770-8040

Other identifiers 2

IdentifierTypeStateIssuer
140000481OtherCACLINIC LICENSE
FHC70603FMedicaidCA

Other names 2

  • Mowry I Doing business as
  • Bay Area Community Health- Mowry I Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100524000507 CA Part A Provider - Federally Qualified Health Center (FQHC) 1658349824 Practice locations: Fremont, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033296272. Details of each certification follow.

Federally qualified health center certification: CCN 051987

Legal name
BAY AREA COMMUNITY HEALTH
Doing business as
BAY AREA COMMUNITY HEALTH- MOWRY I CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 1, 1996
Last certification
May 1, 1996
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 2020 in CA
Enrollment address
2299 Mowry Ave
Ste 3B
Fremont, CA 94538-1621

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
Tri City Family Plannin32 organizations share this tax ID, including this one
Part of
Tri City Family Plannin

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
David E Perez Individual Corporate DirectorBoard Member Jan 28, 2018
Jagat Sheth Individual Corporate OfficerCfo Nov 15, 2018
W-2 Managing EmployeeCfo Nov 15, 2018
Operational/Managerial ControlCfo Nov 15, 2018
Marvin L Wong Individual Corporate DirectorBoard Member Aug 27, 2018
Kobin Lee Individual Corporate DirectorVice Chair/Board Member Nov 15, 2019
Ana I Alvarez Individual Corporate DirectorBoard Member Dec 1, 2013
Anand Marudavanan Individual Corporate DirectorBoard Member Nov 15, 2018
Jacqueline B Belser Individual Corporate DirectorSecretary/Board Member Nov 15, 2018
Yueqin Feng Individual Corporate DirectorBoard Member Nov 15, 2018
Zettie D Page Individual Corporate OfficerCeo Nov 15, 2018 100%
W-2 Managing EmployeeCeo Nov 15, 2018 100%
Operational/Managerial ControlCeo Jun 1, 2020 100%
Sherland D Headley Individual Corporate DirectorBoard Member Nov 15, 2018
Bella I Mello Individual W-2 Managing EmployeeRevenue Cycle Manager Nov 15, 2018
Operational/Managerial ControlRevenue Cycle Manager Nov 15, 2018
Xianzhong Zhu Individual Corporate DirectorTreasurer/Board Member Nov 15, 2018
Brenda L Quillin Individual Corporate DirectorBoard Member Nov 15, 2016
Stephanie J Reddell Individual Corporate DirectorBoard Member Nov 15, 2018
Najia Hamid Individual Corporate DirectorBoard Member Nov 15, 2018
Robert J Wyckoff Individual Corporate OfficerBoard Chair/Board Member Nov 15, 2018

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Gilroy Health ClinicGilroy, CA, CCN 751868 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Bach Family ClinicSan Jose, CA, CCN 751182 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 1, 2020
Nov 15, 2018
Monterey Plaza Health ClinicSan Jose, CA, CCN 751869 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Mt. Pleasant School Based ClinicSan Jose, CA, CCN 751867 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Bay Area Community Health

    dba Monterey Plaza Health Clinic

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1598387680

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba Mt. Pleasant Health Center

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1659993699

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba Bay Area Community Health Center Of Gilroy

    • Federally Qualified Health Center (FQHC)
    • Gilroy, CA
    • NPI 1871115964

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba BACH Family Clinic

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1962024059

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648771200000",
    "number": "1033296272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40910 FREMONT BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945384375",
            "telephone_number": "510-770-8040",
            "fax_number": "510-623-8926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2299 MOWRY AVE STE 3B",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381621",
            "telephone_number": "510-770-8040",
            "fax_number": "510-623-8926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAY AREA COMMUNITY HEALTH",
        "enumeration_date": "2006-11-01",
        "last_updated": "2022-04-01",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "PAGE",
        "authorized_official_first_name": "ZETTIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-252-6811",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD, PH.D, MBA, MSW,"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC LICENSE",
            "identifier": "140000481",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70603F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mowry I",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mowry I",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bay Area Community Health- Mowry I Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.