NPIMap

Organization Active NPI

Apex Annex Health Center,Inc

  • Rural Health Clinic/Center
  • Los Banos, CA
National Provider Identifier
1215484142
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
APEX ANNEX HEALTH CENTER,INC
Practice address
400 West I Street
Suite a
Los Banos, CA 93635
Phone
(209) 827-9999
Fax
(209) 827-0011
NPI assigned
Sep 8, 2016
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Deborah Diane Perry
Title
Administrator
Phone
(209) 826-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X CA Primary

Addresses

Primary practice location

400 West I Street
Suite a
Los Banos, CA 93635

Mailing address

400 W I St
Suite a
Los Banos, CA 93635-3459
Phone (209) 827-9999

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180503000619 CA Part A Provider - Rural Health Clinic 6002190451 Practice locations: Los Banos, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215484142. Details of each certification follow.

Rural health clinic certification: CCN 058998

Legal name
APEX ANNEX HEALTH CENTER,INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 30, 2018
Last certification
Oct 30, 2018
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Aug 26, 2016 in CA
Enrollment address
400 W I St
Ste a
Los Banos, CA 93635-3459

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2170575Apex Annex Health Center, Inc400 West I Street Suite a, Los Banos, CA 93635Certificate of waiverAug 13, 2027

National Provider Directory

National Provider Directory

Locations

400 W I St
Ste A
Los Banos, CA 93635
Phone (209) 826-3200

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Karthikeya Devireddy Individual 5% Or Greater Direct Ownership InterestCeo Aug 18, 2016 70%
Corporate OfficerCeo Aug 18, 2016 70%
Deborah Perry Individual 5% Or Greater Direct Ownership InterestBoard of Director/Secretary Aug 18, 2016 30%
W-2 Managing EmployeeAdministrator Aug 18, 2016 30%

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": "1473292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1215484142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 W I ST",
            "address_2": "SUITE A",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936353459",
            "telephone_number": "209-827-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 WEST I STREET",
            "address_2": "SUITE A",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "93635",
            "telephone_number": "209-827-9999",
            "fax_number": "209-827-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APEX ANNEX HEALTH CENTER,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "209-826-2222"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Banos, CA

Sources for this page

Verify at the official NPI Registry.