NPIMap

Organization Active NPI

Wellspace Health

  • Federally Qualified Health Center (FQHC)
  • Martell, CA
National Provider Identifier
1225550874
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
Practice address
11333 Prospect Drive
Martell, CA 95645-9998
Phone
(209) 268-0560
Fax
(209) 214-6946
NPI assigned
Jul 14, 2017
Organization subpart
Yes
Parent organization
WELLSPACE HEALTHAs reported in NPPES

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) 313-8413

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
ContractorGroup: 193200000X MULTI-SPECIALTY GROUP 171W00000X
Developmentally Disabled Services Day Training Agency 251C00000X
Supports Brokerage Agency 251X00000X
Federally Qualified Health Center (FQHC) 261QF0400X CA Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Home Delivered Meals 332U00000X
Personal Care AttendantGroup: 193200000X MULTI-SPECIALTY GROUP 3747P1801X
Respite Care 385H00000X

Addresses

Primary practice location

11333 Prospect Drive
Martell, CA 95645-9998

Mailing address

777 12TH St Ste 250
Sacramento, CA 95814-1929
Phone (916) 550-5481

Medicare participation

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

Enrollment records 2

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
O20180829000270 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426157975 Practice locations: Martell, CA

Federally qualified health center certification: CCN 921092

Legal name
WELLSPACE HEALTH
Doing business as
WELLSPACE HEALTH AMADOR COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 28, 2018
Last certification
Aug 28, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1970 in CA
Enrollment address
11333 Prospect Drive
Martell, CA 95654-9998

Other NPIs with the same Medicare PAC ID 16

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

View all 16

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
Part of
The Effort Inc Detox

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Brenda a Shipp Individual Corporate OfficerChief Operations Officer Jun 9, 2014
W-2 Managing EmployeeChief Operations Officer Jun 9, 2014
Operational/Managerial ControlChief Operations Officer Jun 9, 2014
Todd Murray Individual Corporate DirectorBoard Director Jul 1, 2017
Lawrence Maas Individual Corporate DirectorBoard Vice President Jul 1, 2016
Lisa Stewart Individual Corporate DirectorBoard President Jul 1, 2016
Timothy Martin Individual Corporate DirectorBoard Director Jul 1, 2017
Kathy Walker Individual Corporate OfficerChief Financial Officer Mar 1, 2013
W-2 Managing EmployeeChief Financial Officer Mar 1, 2013
Operational/Managerial ControlChief Financial Officer Mar 1, 2013
James Tilton Individual Corporate DirectorBoard Director Jul 1, 2016
Jonathan a Porteus Individual Corporate OfficerChief Executive Officer Jan 1, 2011
W-2 Managing EmployeeChief Executive Officer Jan 1, 2011
Operational/Managerial ControlChief Executive Officer Jan 1, 2011
Ruzwa Cooper Individual Corporate DirectorBoard Treasurer Jul 1, 2016
Janine Vivienne Bera Individual Corporate OfficerChief Medical Officer Jun 1, 2017
W-2 Managing EmployeeChief Medical Officer Jun 1, 2017
Operational/Managerial ControlChief Medical Officer Jun 1, 2017
Jo Ann 'Jody' Gray Individual Corporate DirectorBoard Director Jul 1, 2016

Owners & managing parties with NPI records 1

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

  • Janine W. Bera, MD
    • Internal Medicine Physician
    • Sacramento, CA
    • NPI 1649358383

    Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

All facility ownership & control disclosures 11

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wellspace HealthSacramento, CA, CCN 051142 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health North Highlands Community Health CenterNorth Highlands, CA, CCN 551020 Federally qualified health center Operational/Managerial Control Nov 27, 2011
Wellspace HealthSacramento, CA, CCN 551021 Federally qualified health center Operational/Managerial Control Jan 4, 2010
Wellspace HealthSacramento, CA, CCN 551022 Federally qualified health center Operational/Managerial Control May 17, 2010
Wellspace HealthRoseville, CA, CCN 751000 Federally qualified health center Operational/Managerial Control Mar 16, 2012
Wellspace Health Healthcare for Women Community Health CenterSacramento, CA, CCN 921070 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921843 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921842 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921841 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sunrise CommunityCitrus Heights, CA, CCN 921844 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sierra Garden 2Roseville, CA, CCN 921840 Federally qualified health center Operational/Managerial Control Feb 7, 1970

Owned or controlled facilities with NPI records 11

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1499990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1225550874",
    "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": "916-550-5481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11333 PROSPECT DRIVE",
            "city": "MARTELL",
            "state": "CA",
            "postal_code": "956459998",
            "telephone_number": "209-268-0560",
            "fax_number": "209-214-6946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPACE HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WELLSPACE HEALTH",
        "enumeration_date": "2017-07-14",
        "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": "916-313-8413",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martell, CA

Sources for this page

Verify at the official NPI Registry.