NPIMap

Organization Active NPI

Clinicas de Salud del Pueblo, Inc

Doing business as Innercare

  • Federally Qualified Health Center (FQHC)
  • Blythe, CA
National Provider Identifier
1124115431
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
250000024 Issued in CA
Legal business name
CLINICAS DE SALUD DEL PUEBLO, INC
Doing business as
Innercare
Innercare - Blythe
Practice address
1415 W Hobsonway
Blythe, CA 92225-1479
Phone
(760) 922-4981
Fax
(760) 922-4442
NPI assigned
Oct 6, 2006
Last updated
Mar 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Yvonne Bell, MBA
Title
Ceo
Phone
(760) 344-9951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 250000024 CA Primary

Addresses

Primary practice location

1415 W Hobsonway
Blythe, CA 92225-1479

Mailing address

852 E Danenberg Dr
El Centro, CA 92243
Phone (760) 344-9951

Other identifiers 3

IdentifierTypeStateIssuer
BCP03863FOtherCACANCER DETECTION PROGRAM
HAP03863FOtherCAFAMILY PACT
FHC038363FMedicaidCA

Other names 2

  • Innercare Doing business as
  • Innercare - Blythe Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040123000568 CA Part A Provider - Federally Qualified Health Center (FQHC) 5496657082 Practice locations: Blythe, CA
O20071201000158 CA Part B Supplier - Clinic/Group Practice 5496657082 Receives reassigned benefits from 148 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winterhaven, CA; Salton City, CA; Niland, CA; Mecca, CA; Indio, CA; El Centro, CA; Hemet, CA; Blythe, CA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124115431. Details of each certification follow.

Federally qualified health center certification: CCN 051849

Legal name
CLINICAS DE SALUD DEL PUEBLO INC
Doing business as
BLYTHE HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 20, 1970 in CA
Enrollment address
321 W Hobsonway
Suite C
Blythe, CA 92225-1651

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 12

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

National Provider Directory

National Provider Directory

Locations

1415 W Hobsonway
Blythe, CA 92225
Phone (760) 544-6996

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Victor Nava Individual Corporate DirectorBoard Member Jan 1, 2010
Georgina Montano Individual Corporate DirectorBoard Member Jan 1, 2005
Jessie de Los Santos Individual Corporate DirectorBoard Member Jan 1, 2011
Elizabeth Moreno Individual Corporate DirectorBoard Member Jan 1, 2007
Juan de Lara Individual Corporate DirectorBoard Member Jan 1, 2011
Yvonne W Bell Individual W-2 Managing EmployeeCeo Dec 9, 2014
Isidoro Romero Individual Corporate DirectorBoard Member Jan 1, 2010
Sergio Cardenas Individual Corporate DirectorBoard Member Jan 1, 2011
Rebecca Terrazas-Baxter Individual Corporate DirectorBoard Member Jan 1, 2011
Nidia Carranza Individual Corporate DirectorBoard Member Jan 1, 2011

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1124115431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 E DANENBERG DR",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "92243",
            "telephone_number": "760-344-9951",
            "fax_number": "760-344-5840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 W HOBSONWAY",
            "city": "BLYTHE",
            "state": "CA",
            "postal_code": "922251479",
            "telephone_number": "760-922-4981",
            "fax_number": "760-922-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAS DE SALUD DEL PUEBLO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "BELL",
        "authorized_official_first_name": "YVONNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-344-9951",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "250000024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CANCER DETECTION PROGRAM",
            "identifier": "BCP03863F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PACT",
            "identifier": "HAP03863F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC038363F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innercare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innercare - Blythe",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Innercare - Blythe",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blythe, CA

Sources for this page

Verify at the official NPI Registry.