Centro de Salud de la Comunidad de San Ysidro Inc
Organization Active NPI Community/Retail Pharmacy · Campo, CA
NPI 1063133015 · NPPES record last updated Sep 23, 2022
Key facts
- NPI
- 1063133015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO INC
- Practice address
- 1388 Buckman Springs Rd
Campo, CA 91906-2028 - Phone
- (619) 662-4100
- NPI assigned
- Sep 8, 2022
- Organization subpart
- No
Authorized official
- Name
- Kevin Mattson
- Title
- President & Ceo
- Phone
- (619) 662-4100
Other NPIs on the same Medicare enrollment 41
Corporate family (same tax ID) 14
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| San Ysidro Health CHC-Ocean View |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Aug 25, 2008 |
| San Ysidro Health Euclid |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Aug 25, 2009 |
| San Ysidro Health Otay |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Feb 5, 1971 |
| San Ysidro Health San Diego Pace/Senior Health Services |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Sep 1, 2014 |
| San Ysidro Health El Cajon/San Diego Pace |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Dec 1, 2015 |
| San Ysidro Health South Bay |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (5%) | Jun 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040130000711 | CA | Part B Supplier - Clinic/Group Practice | 6901709435 |
Receives reassigned benefits from 611 practitioners 41 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: National City, CA; San Diego, CA; San Ysidro, CA; Santee, CA; Vista, CA; Alpine, CA; Campo, CA; Chula Vista, CA… |
| O20221201002301 | CA | Part B Supplier - Pharmacy | 6901709435 |
4 other NPIs on this enrollment Practice locations: San Diego, CA; San Ysidro, CA; National City, CA; Campo, CA |
National Provider Directory
- Tax ID family
- Centro de Salud de la Comun
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
1388 Buckman Springs Rd
Campo, CA 91906-2028
Mailing address
1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 662-4100
Other names
- San Ysidro Health Pharmacy Mountain Health
Other providers in Campo, CA
- Corinna D. Bynum
- Jeanette Cabanilla
- Chantal Camarena
- Ann Carter
- Corey Adam Cartwright
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Centro de Salud de la Comunidad de San Ysidro, Inc.
- Natalie Chavez
- Roy Colbourne
- Lucas Anthony Cook
All providers in Campo, CA · Community/Retail Pharmacy 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 23, 2022. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.