NPIMap

Organization Active NPI

Gardner Family Health Network Inc

Doing business as Gardner South County

  • Federally Qualified Health Center (FQHC)
  • Gilroy, CA
National Provider Identifier
1144358748
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
FHC707872F Issued in CA
Legal business name
GARDNER FAMILY HEALTH NETWORK INC
Doing business as
Gardner South County
Practice address
7526 Monterey St
Gilroy, CA 95020-5826
Phone
(408) 935-3933
Fax
(408) 935-3988
NPI assigned
Mar 2, 2007
Last updated
May 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
GARDNER FAMILY HEALTH NETWORK INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Authorized official

Name
Ofelia Ruiz
Title
Director
Phone
(408) 935-3971

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X FHC707872F CA Primary
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

7526 Monterey St
Gilroy, CA 95020-5826

Mailing address

PO Box 1240
Alviso, CA 95002-1240
Phone (408) 935-3933

Other identifiers 4

IdentifierTypeStateIssuer
FHC70872FMedicaidCA
HAP70872FOtherCASOFPGIL
BCP707872FOtherCABCEDPGIL
EAP707872FOtherCAEAPCGIL

Other names 1

  • GARDNER SOUTH COUNTY Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090128000177 CA Part A Provider - Federally Qualified Health Center (FQHC) 5890859375 Practice locations: Gilroy, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144358748. Details of each certification follow.

Federally qualified health center certification: CCN 051150

Legal name
GARDNER FAMILY HEALTH NETWORK INC
Doing business as
GARDNER SOUTH COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2009
Last certification
Feb 24, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 26, 1988 in CA
Enrollment address
7526 Monterey St
Gilroy, CA 95020-5826

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Family Health Fndtn Alv33 organizations share this tax ID, including this one
Part of
Family Health Fndtn Alv

Other organizations with this tax ID 32

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

View all 32

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Rafael Vaquerano Individual Corporate OfficerCeo Jan 12, 2024
Hilda Bocanegra Individual Corporate Director Dec 28, 2017
Allison L Escho Individual Corporate Director May 1, 2016
Adolfo Gomez Porras Individual Corporate Director Jan 1, 2015
Guillermo Viveros Individual Corporate Director Jan 1, 2017
William Roth Individual Corporate Director Mar 1, 2015
Noe Pablo Lozano Individual Corporate DirectorBoard Member Jul 1, 1997
Efrain Coria Individual Corporate OfficerCfo Jul 1, 1997
W-2 Managing Employee Jul 1, 1997
Frank V Serrano Individual Corporate Director Jun 15, 2004
Patricia Gutierrez Individual Corporate Director Jan 1, 2015
Kenneth L del Conte Individual Corporate Director Apr 28, 2022

NPI Registry JSON

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1144358748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1240",
            "city": "ALVISO",
            "state": "CA",
            "postal_code": "950021240",
            "telephone_number": "408-935-3933",
            "fax_number": "408-935-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7526 MONTEREY ST",
            "city": "GILROY",
            "state": "CA",
            "postal_code": "950205826",
            "telephone_number": "408-935-3933",
            "fax_number": "408-935-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDNER FAMILY HEALTH NETWORK INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GARDNER FAMILY HEALTH NETWORK INC",
        "enumeration_date": "2007-03-02",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "OFELIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "408-935-3971"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "FHC707872F",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70872F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOFPGIL",
            "identifier": "HAP70872F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCEDPGIL",
            "identifier": "BCP707872F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPCGIL",
            "identifier": "EAP707872F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GARDNER SOUTH COUNTY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GARDNER SOUTH COUNTY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gilroy, CA

Sources for this page

Verify at the official NPI Registry.