NPIMap

Organization Active NPI

Community Health Centers of the Central Coast Inc

Doing business as Community Health Centers Del Valle

  • Clinic/Center
  • Santa Maria, CA
National Provider Identifier
1174911317
Registry record updated Jan 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Doing business as
Community Health Centers Del Valle
Practice address
430 S Blosser Rd
Santa Maria, CA 93458-4908
Phone
(805) 361-8900
Fax
(805) 361-8990
NPI assigned
Dec 22, 2014
Last updated
Jan 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2019

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

Authorized official

Name
Ronald E Castle
Title
Chief Executive Officer
Phone
(805) 361-8014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

430 S Blosser Rd
Santa Maria, CA 93458-4908

Mailing address

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

Other names 1

  • Community Health Centers Del Valle Doing business as

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…
O20150902001289 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 1174911317. Details of each certification follow.

Federally qualified health center certification: CCN 751170

Legal name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 2, 2015
Last certification
Sep 2, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1978 in CA
Enrollment address
430 S Blosser Rd
Santa Maria, CA 93458-4908

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

Locations

1835 N Broadway
Santa Maria, CA 93454
Phone (805) 345-3701

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 DirectorBoard Member Jul 1, 2015 5%
Lue Thao Individual Corporate OfficerChief Financial Officer May 1, 2025 5%
Ronald E Castle Individual Corporate OfficerChief Executive Officer Jul 1, 2015 10%
Barbara a Allen Individual Operational/Managerial ControlBusiness Office Manager Jul 1, 2015 5%
William Gordon Individual Corporate DirectorBoard of Director President Jul 1, 2015 5%

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1419206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548028800000",
    "number": "1174911317",
    "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": "430 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934584908",
            "telephone_number": "805-361-8900",
            "fax_number": "805-361-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-22",
        "last_updated": "2019-01-21",
        "status": "A",
        "authorized_official_last_name": "CASTLE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "805-361-8014"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Centers Del Valle",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Health Centers Del Valle",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Maria, CA

Sources for this page

Verify at the official NPI Registry.