Freedom Choice Healthcare Inc
Organization Active NPI Primary Care Clinic/Center · San Jose, CA
NPI 1164968178 · NPPES record last updated Mar 10, 2022
Key facts
- NPI
- 1164968178
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- A101639 (CA)
- Legal business name
- FREEDOM CHOICE HEALTHCARE INC
- Practice address
- 2690 S White Rd
Suite 95
San Jose, CA 95148-2076 - Phone
- (408) 223-8080
- NPI assigned
- Jan 13, 2017
- Organization subpart
- No
Authorized official
- Name
- Mr. Miguel A Darantes, MD
- Title
- Medical Director/Owner
- Phone
- (408) 223-8080
Practitioners 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2131285 | Freedom Choice Clinic | Certificate of waiver | May 24, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170523001297 | CA | Part B Supplier - Clinic/Group Practice | 3870860877 |
Receives reassigned benefits from 1 practitioner Practice locations: San Jose, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | A101639 | CA | Yes |
Addresses
Primary practice location
2690 S White Rd
Suite 95
San Jose, CA 95148-2076
Mailing address
2690 S. White Rd
#20
San Jose, CA 95148-2076
Phone (408) 223-8080
Other names
- Freedom Choice Clinic
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All providers in San Jose, CA · Primary Care Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.