NPIMap

Organization Active NPI

Indian Health Center of Santa Clara Valley

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1114290780
Registry record updated Feb 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001941 Issued in CA
Legal business name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Practice address
455 Oconnor Dr Ste 200
San Jose, CA 95128-1632
Phone
(408) 445-3400
Fax
(408) 448-1727
NPI assigned
Feb 13, 2012
Organization subpart
Yes
Parent organization
INDIAN HEALTH CENTER OF SANTA CLARA VALLEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 7, 2013

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

Authorized official

Name
Dr. Aldon Wayne Scott, D. M.
Title
Director of Operations
Phone
(408) 445-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550001941 CA Primary

Addresses

Primary practice location

455 Oconnor Dr Ste 200
San Jose, CA 95128-1632

Mailing address

1333 Meridian Ave
San Jose, CA 95125-5212
Phone (408) 445-3400

Other identifiers 4

IdentifierTypeStateIssuer
G01133-01OtherCADELTA DENTAL
55-1137OtherCAMEDICARE PALMETTO
FHC11833FOtherCASTATE PROGRAMS
FHC11833FMedicaidCA

Other names 1

  • Indian Health Center of Santa Clara Valley - Family Medicine Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120126000250 CA Part B Supplier - Clinic/Group Practice 1153406665 Receives reassigned benefits from 94 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Jose, CA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Indian Health Center of Santa Clara

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1329091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360195200000",
    "number": "1114290780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MERIDIAN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255212",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 OCONNOR DR STE 200",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951281632",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "enumeration_date": "2012-02-13",
        "last_updated": "2013-02-07",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "ALDON",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "408-445-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D. M."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "G01133-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PALMETTO",
            "identifier": "55-1137",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROGRAMS",
            "identifier": "FHC11833F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11833F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Health Center of Santa Clara Valley - Family Medicine Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; 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.