NPIMap

Organization Active NPI

Wellspace Health

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1104210608
Registry record updated Aug 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WELLSPACE HEALTH
Practice address
3535 65TH St
Suite C
Sacramento, CA 95820-2057
Phone
(916) 737-5555
Fax
(916) 444-5620
NPI assigned
Mar 23, 2015
Last updated
Aug 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2017

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

Authorized official

Name
Mr. Alasdair Jonathan Porteus, PHD
Title
Chief Executive Officer
Phone
(916) 737-5555

Specialties & licenses 1

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

Addresses

Primary practice location

3535 65TH St
Suite C
Sacramento, CA 95820-2057

Mailing address

1820 J Street
Sacramento, CA 95811
Phone (916) 550-5481

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070623000117 CA Part B Supplier - Clinic/Group Practice 8426157975 Receives reassigned benefits from 123 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Jackson, CA; Citrus Heights, CA; Folsom, CA; North Highlands, CA; Roseville, CA

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory

Locations

3535 65th St
Ste C
Sacramento, CA 95820
Phone (916) 318-6219

7601 Hospital Dr
Ste 220
Sacramento, CA 95823
Phone (916) 689-3433

Practitioners & affiliated clinicians

Practitioners 12

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": "1427068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502841600000",
    "number": "1104210608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 J STREET",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95811",
            "telephone_number": "916-550-5481",
            "fax_number": "916-822-8974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 65TH ST",
            "address_2": "SUITE C",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958202057",
            "telephone_number": "916-737-5555",
            "fax_number": "916-444-5620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPACE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-23",
        "last_updated": "2017-08-16",
        "status": "A",
        "authorized_official_last_name": "PORTEUS",
        "authorized_official_first_name": "ALASDAIR",
        "authorized_official_middle_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "916-737-5555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2017; 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.