NPIMap

Organization Active NPI

Community Health Centers of the Central Coast Inc

Doing business as Community Health Centers Womens Health

  • Federally Qualified Health Center (FQHC)
  • San Luis Obispo, CA
National Provider Identifier
1124045158
Registry record updated Jan 21, 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
Doing business as
Community Health Centers Womens Health
Practice address
1551 Bishop St
Suite 240
San Luis Obispo, CA 93401-4635
Phone
(805) 549-0402
Fax
(805) 549-0465
NPI assigned
Jul 16, 2006
Last updated
Jan 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2019

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

Authorized official

Name
Ronald E Castle
Title
Chief Executive Officer
Phone
(805) 361-8014

Specialties & licenses 1

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

Addresses

Primary practice location

1551 Bishop St
Suite 240
San Luis Obispo, CA 93401-4635

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8028

Other names 1

  • Community Health Centers Womens Health Doing business as

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…
O20040714001597 CA Part A Provider - Federally Qualified Health Center (FQHC) 7416868120 Practice locations: San Luis Obispo, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124045158. Details of each certification follow.

Federally qualified health center certification: CCN 551982

Legal name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 9, 2004
Last certification
Aug 9, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 4, 1978 in CA
Enrollment address
1551 Bishop St
Ste 240
San Luis Obispo, CA 93401-4661
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
Comm HLTH CTRS CNTL CST22 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 5

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 Member Jul 20, 2004 5%
Linda L Costa Individual Corporate OfficerChief Financial Officer Jan 2, 2017 5%
Ronald E Castle Individual Corporate DirectorChief Executive Officer Jul 20, 2004 5%
W-2 Managing EmployeeCheif Executive Officer Sep 12, 1978 5%
Barbara a Allen Individual W-2 Managing EmployeeBusiness Office Manager Apr 1, 1978 5%
William Gordon Individual Corporate DirectorBoard Member Jan 1, 2012 5%

Practitioners & affiliated clinicians

Practitioners 3

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": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548028800000",
    "number": "1124045158",
    "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": "805-361-8028",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 BISHOP ST",
            "address_2": "SUITE 240",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014635",
            "telephone_number": "805-549-0402",
            "fax_number": "805-549-0465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2019-01-21",
        "status": "A",
        "authorized_official_last_name": "CASTLE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "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 Womens Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.