NPIMap

Organization Active NPI

San Jose Foothill Family Community Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1053855312
Registry record updated Mar 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC.
Practice address
1776 Educational Park Dr
N Building
San Jose, CA 95133-1703
Phone
(408) 928-6130
NPI assigned
Dec 6, 2016
Last updated
Mar 8, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2018

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

Authorized official

Name
Mr. Salvador Chavarin
Title
Ceo
Phone
(408) 729-4290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1776 Educational Park Dr
N Building
San Jose, CA 95133-1703

Mailing address

2670 S White Rd
Suite 200
San Jose, CA 95148-2071
Phone (408) 729-4290

Other names 1

  • Foothill Health Center, Inc. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053855312. Details of each certification follow.

  • CCN 921048 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921048

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
INDEPENDENDENCE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 4, 2018
Last certification
Apr 4, 2018
Ownership / control type
For profit – corporation
Facility address
1776 Educational Park Drive
San Jose, CA 95133

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1480982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520467200000",
    "number": "1053855312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 S WHITE RD",
            "address_2": "SUITE 200",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951482071",
            "telephone_number": "408-729-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 EDUCATIONAL PARK DR",
            "address_2": "N BUILDING",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951331703",
            "telephone_number": "408-928-6130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-06",
        "last_updated": "2018-03-08",
        "status": "A",
        "authorized_official_last_name": "CHAVARIN",
        "authorized_official_first_name": "SALVADOR",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "408-729-4290",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foothill Health Center, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.