NPIMap

Organization Active NPI

Pacific Central Coast Health Centers

Doing business as Coastal Valley Health Center

  • Community Health Clinic/Center
  • Santa Maria, CA
National Provider Identifier
1225307317
Registry record updated Nov 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
PACIFIC CENTRAL COAST HEALTH CENTERS
Doing business as
Coastal Valley Health Center
Practice address
1510 E Main St
Suite 104-C
Santa Maria, CA 93454-4825
Phone
(805) 349-8514
Fax
(805) 614-0223
NPI assigned
Dec 20, 2011
Last updated
Nov 12, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
PACIFIC CENTRAL COAST HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 12, 2018

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

Authorized official

Name
Matthew Richardson
Title
Chief Financial Officer
Phone
(805) 739-3108

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

1510 E Main St
Suite 104-C
Santa Maria, CA 93454-4825

Mailing address

117 W Bunny Ave
Santa Maria, CA 93458-2805
Phone (805) 349-8514

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ06481ZOtherBSCA

Other names 1

  • Coastal Valley 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
O20031103000443 CA Part B Supplier - Clinic/Group Practice 9739091364 Receives reassigned benefits from 305 practitioners
This NPI is an additional NPI on the enrollment

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
05D2045549Coastal Valley Health Center1510 E Main St Ste 104C, Santa Maria, CA 93454Certificate of waiverAug 14, 2026

National Provider Directory

National Provider Directory
Part of
Pacific Central Coast HLTH

Practitioners & affiliated clinicians

Practitioners 12

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": "1324339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541980800000",
    "number": "1225307317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W BUNNY AVE",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934582805",
            "telephone_number": "805-349-8514",
            "fax_number": "805-349-8958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 E MAIN ST",
            "address_2": "SUITE 104-C",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934544825",
            "telephone_number": "805-349-8514",
            "fax_number": "805-614-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CENTRAL COAST HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PACIFIC CENTRAL COAST HEALTH CENTERS",
        "enumeration_date": "2011-12-20",
        "last_updated": "2018-11-12",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "805-739-3108"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSCA",
            "identifier": "ZZZ06481Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coastal Valley Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Coastal Valley Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Maria, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.