NPIMap

Organization Active NPI

Wellspace Health

Doing business as WellSpace Health Folsom Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Folsom, CA
National Provider Identifier
1215438676
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WELLSPACE HEALTH
Doing business as
WellSpace Health Folsom Community Health Center
Practice address
1710 Prairie City Rd
Folsom, CA 95630-9592
Phone
(916) 407-2222
Fax
(916) 797-0340
NPI assigned
Feb 21, 2018
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Alasdair Jonathan Porteus, PHD
Title
Chief Executive Officer
Phone
(916) 550-5424

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Contractor 171W00000X NU
Developmentally Disabled Services Day Training Agency 251C00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X CA Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Home Delivered Meals 332U00000X NU
Personal Care Attendant 3747P1801X NU
Respite Care 385H00000X NU
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

1710 Prairie City Rd
Folsom, CA 95630-9592

Mailing address

777 12TH St Ste 250
Sacramento, CA 95814-1929
Phone (916) 550-5444

Other names 1

  • WellSpace Health Folsom Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070623000117 CA Part B Supplier - Clinic/Group Practice 8426157975 Receives reassigned benefits from 123 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Jackson, CA; Citrus Heights, CA; Folsom, CA; North Highlands, CA; Roseville, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215438676. Details of each certification follow.

  • CCN 921845 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921845

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WELLSPACE HEALTH FOLSOM COMMUNITY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 18, 2020
Last certification
Feb 18, 2020
Ownership / control type
For profit – corporation
Facility address
1710 Prairie City Rd Suite 125
Folsom, CA 95630

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1215438676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 12TH ST STE 250",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958141929",
            "telephone_number": "916-550-5444",
            "fax_number": "916-436-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 PRAIRIE CITY RD",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "956309592",
            "telephone_number": "916-407-2222",
            "fax_number": "916-797-0340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPACE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "PORTEUS",
        "authorized_official_first_name": "ALASDAIR",
        "authorized_official_middle_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "916-550-5424",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpace Health Folsom Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Folsom, CA

Sources for this page

Verify at the official NPI Registry.