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Community Health Centers of the Central Coast Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · San Luis Obispo, CA

NPI 1124045158 · NPPES record last updated Jan 21, 2019

Key facts

NPI
1124045158
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
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
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 27

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

View all 27

Other NPIs with the same Medicare PAC ID 22

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 21

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Practitioners 77

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

View all 77

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

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
Corporation · Non-profit
Incorporated
May 4, 1978 in CA
Enrollment address
1551 Bishop St
Ste 240
San Luis Obispo, CA 93401-4661
Related CCNs
051847

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 Director
Board Member		 Jul 20, 2004 5%
Linda L Costa
Individual 		Corporate Officer
Chief Financial Officer		 Jan 2, 2017 5%
Ronald E Castle
Individual 		Corporate Director
Chief Executive Officer		 Jul 20, 2004 5%
W-2 Managing Employee
Cheif Executive Officer		 Sep 12, 1978 5%
Barbara a Allen
Individual 		W-2 Managing Employee
Business Office Manager		 Apr 1, 1978 5%
William Gordon
Individual 		Corporate Director
Board Member		 Jan 1, 2012 5%

Medicare enrollment records

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

National Provider Directory

Tax ID family
Comm HLTH CTRS of the C (22 organizations share this tax ID)

Locations

1551 Bishop St
Ste 240
Sn Luis Obisp, CA 93401
Phone (805) 434-1038

Specialties & licenses

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

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

  • Community Health Centers Womens Health Doing business as

Other providers in San Luis Obispo, CA

All providers in San Luis Obispo, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.