NPIMap

Organization Active NPI

Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Santa Maria, CA
National Provider Identifier
1174859425
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Practice address
1418 E Main St
Suite 210
Santa Maria, CA 93454-4833
Phone
(805) 928-3678
Fax
(805) 928-6408
NPI assigned
Oct 21, 2009
Last updated
Dec 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Authorized official

Name
Barbara A Allen
Title
Director of Business Office
Phone
(805) 361-8014

Specialties & licenses 1

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

Addresses

Primary practice location

1418 E Main St
Suite 210
Santa Maria, CA 93454-4833

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8028

Other names 1

  • CHC Arbor Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040115001161 CA Part B Supplier - Clinic/Group Practice 7416868120 Receives reassigned benefits from 236 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Maria, CA; Paso Robles, CA; San Luis Obispo, CA; Templeton, CA; Oceano, CA; Arroyo Grande, CA; Atascadero, CA; Cambria, CA…
O20110126000292 CA Part A Provider - Federally Qualified Health Center (FQHC) 7416868120 Practice locations: Santa Maria, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174859425. Details of each certification follow.

Federally qualified health center certification: CCN 551185

Legal name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 26, 2011
Last certification
Jan 26, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1978 in CA
Enrollment address
1418E Main St 210
Santa Maria, CA 93454-4836

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
Comm HLTH CTRS-Morro Bay22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Bertha Campos Individual Corporate OfficerBoard Member Jan 1, 2010 5%
Ronald E Castle Individual Corporate Director Jan 1, 2010 10%
Barbara a Allen Individual W-2 Managing Employee Jan 1, 2010
John a Khan-Variba Individual Corporate Director Jan 1, 2010
William Gordon Individual Corporate OfficerBoard Member President May 1, 2014 5%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1174859425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8028",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1418 E MAIN ST",
            "address_2": "SUITE 210",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544833",
            "telephone_number": "805-928-3678",
            "fax_number": "805-928-6408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-21",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS OFFICE",
        "authorized_official_telephone_number": "805-361-8014"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHC Arbor",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "CHC Arbor",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.