NPIMap

Organization Active NPI

Roots Community Health Center

  • Primary Care Clinic/Center
  • Oakland, CA
National Provider Identifier
1083858823
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
ROOTS COMMUNITY HEALTH CENTER
Practice address
9925 International Blvd
#5
Oakland, CA 94603-2558
Phone
(510) 777-1177
NPI assigned
Apr 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Authorized official

Name
Jerusha Norman
Title
Compliance Administrator
Phone
(510) 994-6849

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
ContractorGroup: 193200000X MULTI-SPECIALTY GROUP 171W00000X
Supports Brokerage Agency 251X00000X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

9925 International Blvd
#5
Oakland, CA 94603-2558

Mailing address

9925 International Blvd
#5
Oakland, CA 94603-2558
Phone (510) 777-1177

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130603000605 CA Part B Supplier - Clinic/Group Practice 8022256007 Receives reassigned benefits from 24 practitioners
Practice locations: Oakland, CA

National Provider Directory

National Provider Directory
Tax ID family
Roots Community Health6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1220 Morello Ave
Ste 101
Martinez, CA 94553
Phone (925) 335-3328

9925 International Blvd
Ste 11
Oakland, CA 94603

2521 Seminary Ave
Ste 1
Oakland, CA 94605
Phone (510) 777-1000

9925 International Blvd
Oakland, CA 94603
Phone (510) 562-3731

9925 International Blvd
Ste 5
Oakland, CA 94603
Phone (510) 777-1177

7272 MacArthur Blvd
Oakland, CA 94605
Phone (510) 533-1248

Practitioners & affiliated clinicians

Practitioners 77

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 77

NPI Registry JSON

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1083858823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9925 INTERNATIONAL BLVD",
            "address_2": "#5",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946032558",
            "telephone_number": "510-777-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9925 INTERNATIONAL BLVD",
            "address_2": "#5",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946032558",
            "telephone_number": "510-777-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-23",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "NORMAN",
        "authorized_official_first_name": "JERUSHA",
        "authorized_official_title_or_position": "COMPLIANCE ADMINISTRATOR",
        "authorized_official_telephone_number": "510-994-6849"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.