NPIMap

Organization Active NPI

South County Community Health Center Inc

  • Primary Care Clinic/Center
  • Mountain View, CA
National Provider Identifier
1164055034
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SOUTH COUNTY COMMUNITY HEALTH CENTER INC
Practice address
900 Miramonte Ave FL 2
Mountain View, CA 94040-2457
Phone
(650) 965-3323
Fax
(650) 321-1560
NPI assigned
Feb 19, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Terri Lynn Thomas
Title
Director of Billing
Phone
(650) 330-7414

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

900 Miramonte Ave FL 2
Mountain View, CA 94040-2457

Mailing address

1885 Bay Rd
East Palo Alto, CA 94303-1312
Phone (650) 330-7400

Other names 1

  • Mayview Community Health Center Mountain View a Member of RFHN Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200403001185 CA Part A Provider - Federally Qualified Health Center (FQHC) 3577474634 Practice locations: Mountain View, CA

Federally qualified health center certification: CCN 551084

Legal name
SOUTH COUNTY COMMUNITY HEALTH CENTER INC
Doing business as
MAYVIEW COMMUNITY HEALTH CENTER MOUNTAIN VIEW A MEMBER OF RA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 13, 2010
Last certification
Nov 13, 2010
Ownership / control type
Non-profit – church related
Most recent change of ownership
Apr 1, 2020 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jun 15, 2000 in CA
Enrollment address
900 Miramonte Ave
FL 2
Mountain View, CA 94040-2457

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Southcommunityhealthcenteri5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

900 Miramonte Ave
Fl 2
Mountain View, CA 94040
Phone (650) 801-1700

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Julio Garcia Individual Corporate OfficerBoard Treasurer Jun 15, 2000
Corporate DirectorBoard Treasurer Jun 15, 2000
Gralyn a Jacques Individual Corporate OfficerCfo May 4, 2011
W-2 Managing EmployeeCfo May 4, 2011
Esmeralda Garcia Individual Corporate DirectorBoard Member Mar 19, 2019
Luisa M Buada Individual Corporate OfficerCeo Nov 24, 2003
W-2 Managing EmployeeCeo Nov 24, 2003
Operational/Managerial ControlCeo Apr 1, 2020
Fred Mondragon Individual Corporate OfficerVice Chairman of Board Dec 1, 2018
Corporate DirectorVice Chairman of Board Dec 1, 2018
South County Community Health Center Inc Organization, East Palo Alto, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2020 100%
Operational/Managerial Control Apr 1, 2020 100%
Marcelline Combs Individual Corporate DirectorBoard Member Mar 12, 2002
Manuel Arteaga Individual Corporate DirectorBoard Member May 14, 2002
Siteri Maravou Individual Corporate Director Jun 21, 2011
Vyjeyanthi S Periyakoil Individual Corporate DirectorBoard Member Jan 15, 2019
Melieni Talakai Individual Corporate OfficerChairman of Board Jun 15, 2000
Corporate DirectorChair of the Board Jun 15, 2000
Senseria Conley Individual Corporate DirectorBoard Member Aug 13, 2002
Genesis Cerna Individual Corporate DirectorBoard Member Nov 20, 2018

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mayview Community Health Center Palo Alto, a Member of Ravenswood FamiPalo Alto, CA, CCN 551050 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Apr 1, 2020
Apr 1, 2020
Mayview Community Health Center Sunnyvale, a Member of Ravenswood FamiSunnyvale, CA, CCN 551085 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control (100%)		 Apr 1, 2020
Apr 1, 2020

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Change-of-ownership history 1

DateEventCounterparty
Apr 1, 2020 Change of OwnershipThis provider was the buyer Mayview Community Health CenterCCN 551084, CA, NPI 1780796540

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1582070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1164055034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1885 BAY RD",
            "city": "EAST PALO ALTO",
            "state": "CA",
            "postal_code": "943031312",
            "telephone_number": "650-330-7400",
            "fax_number": "650-321-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MIRAMONTE AVE FL 2",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940402457",
            "telephone_number": "650-965-3323",
            "fax_number": "650-321-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-19",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "650-330-7414"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mayview Community Health Center Mountain View a Member of RFHN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mountain View, CA

Sources for this page

Verify at the official NPI Registry.