NPIMap

Organization Active NPI

Community Medical Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Stockton, CA
National Provider Identifier
1164586772
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
0300000561 Issued in CA
Legal business name
COMMUNITY MEDICAL CENTERS, INC.
Practice address
2640 E Lafayette St
Stockton, CA 95205-5713
Phone
(209) 933-7232
Fax
(209) 466-6527
NPI assigned
Dec 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Michael H. Kirkpatrick
Title
Chief Executive Officer
Phone
(209) 373-2833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 0300000561 CA Primary

Addresses

Primary practice location

2640 E Lafayette St
Stockton, CA 95205-5713

Mailing address

P. O. Box 779
7210 Murray Dr
Stockton, CA 95201-0779
Phone (209) 373-2833

Other identifiers 1

IdentifierTypeStateIssuer
FHC70629FMedicaidCA

Other names 1

  • King Family Center Health Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101027000870 CA Part B Supplier - Clinic/Group Practice 8426968520 Receives reassigned benefits from 171 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vacaville, CA; Tracy, CA; Stockton, CA; Manteca, CA; Lodi, CA; Esparto, CA; Dixon, CA

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory

Locations

1031 Waterloo Rd
Stockton, CA 95205
Phone (209) 940-5600

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164586772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 779",
            "address_2": "7210 MURRAY DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952010779",
            "telephone_number": "209-373-2833",
            "fax_number": "209-373-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 E LAFAYETTE ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952055713",
            "telephone_number": "209-933-7232",
            "fax_number": "209-466-6527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIRKPATRICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "209-373-2833",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "0300000561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70629F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King Family Center Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.