Riverside-San Bernardino County Indian Health, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Thermal, CA
NPI 1043363641 · NPPES record last updated Sep 10, 2021
Key facts
- NPI
- 1043363641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.
- Practice address
- 66655 Martinez Rd
Thermal, CA 92274-9007 - Phone
- (760) 397-4476
- Fax
- (760) 397-0066
- NPI assigned
- Jan 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. William Thomsen
- Title
- Ceo
- Phone
- (909) 864-1097
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 19
Member of 1
Practitioners 55
-
Daniel R. Crogan, MD
-
Jean T Dinh, OD
-
Donald L Hamby, D.O.
-
Brian Thomas Haven, DPM
-
Arthur Leitzke, M.D.
-
Tracie Michelle Noble, NURSE PRACTITIONER
-
Elpidio Querubin, NP
-
Sameera Ahmad, OD
-
Margaret Akua Amoo, NURSE PRACTITIONER
-
Craig F Callam, APRN, FNP-BC
-
John Austin Davis, PSY.D.
-
Eric Eschweiler, DNP, RN, FNP-C
-
April Michelle Figueroa, FNP-C
-
Ashley Fonseca-Tweed, FNP-BC
-
Mallory Adele Kennedy, O.D.
-
Ebrahim Ahmed Mohamedy, M.D.
-
Pamela Enjema Mokoko, FAMILY NURSE PRACTIT
-
Ngoc Kim Nguyen, RN MSN FNP-BC CMSRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI, TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110328000706 | WI | Part a Provider - Indian Health Services Facility | 4789867805 | Practice locations: Thermal, CA |
| O20150508001121 | TX | Part B Supplier - Clinic/Group Practice | 4789867805 |
Receives reassigned benefits from 98 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Thermal, CA; Temecula, CA; San Jacinto, CA; Grand Terrace, CA; Mountain Center, CA; Anza, CA; Barstow, CA; Banning, CA |
National Provider Directory
- Tax ID family
- Riverside San Bernandin
Locations
11555 Potrero Rd
#1-2
Banning, CA 92220
Phone (909) 849-4761
66735 Martinez Rd
Thermal, CA 92274
Phone 7603974476 ext. 3620
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
66655 Martinez Rd
Thermal, CA 92274-9007
Mailing address
11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097
Other names
- Torres Martinez Indian Health
Other providers in Thermal, CA
- Diana Rios
- Riverside County Latino Commission on Alcohol and Drug Abuse Services,
- Riverside County Latino Commission on Alcohol and Drug Abuse Services,
- Riverside County Latino Commission on Alcohol and Drug Services, Inc
- Riverside San Bernardino County Indian Health Inc
- Vincent Antonio Rodriguez
- Itari Anali Romero
- Mercay Margaret Romero
- Steven Anthony Rosales
- Michelle Salgado
All providers in Thermal, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.