NPIMap

Organization Active NPI

Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Atascadero, CA
National Provider Identifier
1073533089
Registry record updated Jan 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Practice address
7512 Morro Rd
Atascadero, CA 93422-4404
Phone
(805) 792-1400
Fax
(805) 792-1485
NPI assigned
Jul 20, 2006
Last updated
Jan 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2019

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

Authorized official

Name
Barbara Allen
Title
Business Office Manager
Phone
(805) 361-8014

Specialties & licenses 1

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

Addresses

Primary practice location

7512 Morro Rd
Atascadero, CA 93422-4404

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8014

Other names 1

  • Community Health Centers Atascadero Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115001161 CA Part B Supplier - Clinic/Group Practice 7416868120 Receives reassigned benefits from 236 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Maria, CA; Paso Robles, CA; San Luis Obispo, CA; Templeton, CA; Oceano, CA; Arroyo Grande, CA; Atascadero, CA; Cambria, CA…
O20040714001602 CA Part A Provider - Federally Qualified Health Center (FQHC) 7416868120 Practice locations: Atascadero, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073533089. Details of each certification follow.

Federally qualified health center certification: CCN 551978

Legal name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Doing business as
COMMUNITY HEALTH CENTERS - ATASCADERO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 29, 2004
Last certification
Jul 29, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 4, 1978 in CA
Enrollment address
7512 Morro Rd
Atascadero, CA 93422-4404
Related CCNs
051847

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
Nipomo Community Med CT22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Bertha Campos Individual Corporate DirectorBoard of Director Jul 20, 2004 5%
Linda L Costa Individual Corporate OfficerChief Financial Officer Nov 1, 2017 5%
Ronald E Castle Individual Corporate OfficerChief Executive Officer Jun 1, 2004 15%
W-2 Managing EmployeeChief Executive Officer Sep 12, 1978 15%
Barbara a Allen Individual W-2 Managing EmployeeBusiness Office Manager Jan 1, 2011 5%
Felicity Lazo Individual Corporate DirectorBoard Member Nov 1, 2012 5%
William Gordon Individual Corporate DirectorBoard of Directors Jan 1, 2011 5%

Practitioners & affiliated clinicians

Practitioners 5

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": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1073533089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8014",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7512 MORRO RD",
            "city": "ATASCADERO",
            "state": "CA",
            "postal_code": "934224404",
            "telephone_number": "805-792-1400",
            "fax_number": "805-792-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "805-361-8014"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Centers Atascadero",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Community Health Centers Atascadero",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Atascadero, CA

Sources for this page

Verify at the official NPI Registry.