NPIMap

Organization Active NPI

Community Medical Centers Inc

Doing business as Community Medical Centers, Channel II

  • Federally Qualified Health Center (FQHC)
  • Stockton, CA
National Provider Identifier
1235745928
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY MEDICAL CENTERS INC
Doing business as
Community Medical Centers, Channel II
Practice address
747 E Channel St
Stockton, CA 95202-2628
Phone
(209) 944-4700
NPI assigned
Sep 18, 2020
Last updated
Sep 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

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

Authorized official

Name
Mrs. Christine C Noguera
Title
Ceo
Phone
(209) 373-2831

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

747 E Channel St
Stockton, CA 95202-2628

Mailing address

7210 Murray Dr
Stockton, CA 95210-3339
Phone (209) 373-2800

Other names 1

  • Community Medical Centers, Channel II Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101027000870 CA Part B Supplier - Clinic/Group Practice 8426968520 Receives reassigned benefits from 171 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vacaville, CA; Tracy, CA; Stockton, CA; Manteca, CA; Lodi, CA; Esparto, CA; Dixon, CA
O20210427001831 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426968520 Practice locations: Stockton, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235745928. Details of each certification follow.

Federally qualified health center certification: CCN 921955

Legal name
COMMUNITY MEDICAL CENTERS, INC.
Doing business as
COMMUNITY MEDICAL CENTERS, 747 CHANNEL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 18, 2021
Last certification
Mar 18, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 19, 1978 in CA
Enrollment address
747 E Channel St
Stockton, CA 95202-2628

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
CMC Inc Dixon Family PR65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 22

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 22

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Ruby V King Individual Corporate DirectorBoard Member Jul 1, 2018
Jaime DG Allen Individual Corporate OfficerCfo Jan 1, 2019
Lily Aman Individual Corporate DirectorBoard Member Jul 1, 1989
Robert Smith Individual Corporate DirectorBoard Member Jul 1, 2013
Pamela Maffei Individual Corporate DirectorBoard Member Jul 1, 2012
Dora Vivero Individual W-2 Managing EmployeeDirector of Revenue Cycle Aug 19, 1996
Christine C Noguera Individual Corporate OfficerCeo Jul 1, 2014
Jasmine Leek Individual Corporate DirectorBoard Member Jul 1, 2015
Martha Robles Individual Corporate DirectorBoard Member Jan 1, 2019
Roger Speed Individual Corporate DirectorBoard Member Jul 1, 2014
Peter W Ragsdale Individual Corporate DirectorBoard Member Jul 1, 2018
Martha Dukes Individual Corporate DirectorBoard Member Jul 1, 1985
Bonnie Brownlee Individual Corporate DirectorBoard Member Jul 1, 2020

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600387200000",
    "number": "1235745928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210 MURRAY DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103339",
            "telephone_number": "209-373-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 E CHANNEL ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952022628",
            "telephone_number": "209-944-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-18",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "NOGUERA",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-373-2831",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Centers, Channel II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.