NPIMap

Organization Active NPI

County of Santa Clara

Doing business as O'Connor Medical Clinic Forest #103

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1093567216
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COUNTY OF SANTA CLARA
Doing business as
O'Connor Medical Clinic Forest #103
Practice address
2100 Forest Ave Ste 103
San Jose, CA 95128-1422
Phone
(408) 454-2626
NPI assigned
Apr 2, 2024
Last updated
Apr 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF SANTA CLARAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
Paul E Lorenz
Title
Chief Executive Officer
Phone
(408) 885-4010

Specialties & licenses 1

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

Addresses

Primary practice location

2100 Forest Ave Ste 103
San Jose, CA 95128-1422

Mailing address

PO Box 103331
Pasadena, CA 91189-3331
Phone (669) 299-8165

Other names 1

  • O'CONNOR MEDICAL CLINIC FOREST #103 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240621002301 CA Part A Provider - Federally Qualified Health Center (FQHC) 1254244973 Practice locations: San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093567216. Details of each certification follow.

Federally qualified health center certification: CCN A01868

Legal name
COUNTY OF SANTA CLARA
Doing business as
SANTA CLARA VALLEY HEALTH & HOSPITAL SYSTEM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 17, 2024
Last certification
Jun 17, 2024
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
2100 Forest Ave
Ste 103
San Jose, CA 95128-1422

National Provider Directory

National Provider Directory
Tax ID family
Santa Clara Cnty Health177 organizations share this tax ID, including this one
Part of
Santa Clara Cnty Health

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2100 Forest Ave
Ste 103104
San Jose, CA 95128

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Vinod Sharma Individual Corporate OfficerChief Financial Officer Dec 27, 2021
County of Santa Clara Organization, San Jose, CA 5% Or Greater Direct Ownership Interest Jan 28, 2021
Paul E Lorenz Individual Corporate OfficerChief Executive Officer, SCVH Nov 19, 2012
W-2 Managing Employee Nov 19, 2012

All facility ownership & control disclosures 23

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Santa Clara Valley Medical CenterSan Jose, CA, CCN 050038 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 30, 2007
Santa Clara Valley Health and Hospital SystemSan Jose, CA, CCN 05T038 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Santa Clara Valley Health and Hospital SystemSan Jose, CA, CCN 05S038 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
O' Connor HospitalSan Jose, CA, CCN 555916 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Santa Clara Health & Hospital SystemSan Jose, CA, CCN 551957 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Santa Clara Health & Hospital SystemMilpitas, CA, CCN 551958 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 3, 2010
Valley Health Center - SunnyvaleSunnyvale, CA, CCN 051051 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 16, 1966
Santa Clara Health & Hospital SystemSan Jose, CA, CCN 051050 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Santa Clara Valley Health and Hospice SystemSan Jose, CA, CCN 051052 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2012
Santa Clara Valley HealthcareSan Jose, CA, CCN 051128 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 7, 2007
Santa Clara Health & Hospital SystemGilroy, CA, CCN 051926 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Santa Clara Valley Health & Hospital SystemSan Jose, CA, CCN 051927 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1966
Valley Health Center AlexianSan Jose, CA, CCN 551049 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Aug 19, 2010
Aug 19, 2010
Valley Health Center at DowntownSan Jose, CA, CCN 751863 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 28, 2016
Santa Clara Valley Health & Hospital SystemSan Jose, CA, CCN A01097 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2019
Santa Clara Valley Health & Hospital SystemSan Jose, CA, CCN A01143 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 1, 1966
Santa Clara Valley Health & Hospital SystemSan Jose, CA, CCN A01169 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2023
Santa Clara Valley Health & Hospital SystemSan Jose, CA, CCN A01168 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 4, 2023
Santa Clara Valley Health & Hospital SystemSan Jose, CA, CCN A01850 Federally qualified health center 5% Or Greater Direct Ownership Interest Dec 13, 2023
Santa Clara Health &Hospital SystemPalo Alto, CA, CCN A01946 Federally qualified health center 5% Or Greater Direct Ownership Interest Apr 16, 2024
Santa Clara Valley Health & Hospital SystemSan Jose, CA, CCN A01922 Federally qualified health center 5% Or Greater Direct Ownership Interest Oct 18, 2021
Santa Clara Valley Health & Hospital SystemMorgan Hill, CA, CCN A01912 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 18, 2024
Santa Clara Health & Hospital SystemSan Jose, CA, CCN A11032 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 22, 2025

Facilities with the same owner 23

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1712016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1093567216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 103331",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911893331",
            "telephone_number": "669-299-8165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 FOREST AVE STE 103",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281422",
            "telephone_number": "408-454-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SANTA CLARA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF SANTA CLARA",
        "enumeration_date": "2024-04-02",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "LORENZ",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "408-885-4010"
    },
    "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": "O'CONNOR MEDICAL CLINIC FOREST #103",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.