NPIMap

Organization Active NPI

Bay Area Community Health

Doing business as Bay Area Community Health Irvington Dave Clinic II

  • Federally Qualified Health Center (FQHC)
  • Fremont, CA
National Provider Identifier
1245719129
Registry record updated May 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BAY AREA COMMUNITY HEALTH
Doing business as
Bay Area Community Health Irvington Dave Clinic II
Practice address
40924 Fremont Blvd
Fremont, CA 94538-4375
Phone
(510) 252-6810
NPI assigned
Aug 10, 2018
Last updated
May 7, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
BAY AREA COMMUNITY HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2021

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

Authorized official

Name
Jagat Sheth, MBA
Title
Cfo
Phone
(510) 252-6810

Specialties & licenses 1

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

Addresses

Primary practice location

40924 Fremont Blvd
Fremont, CA 94538-4375

Mailing address

40910 Fremont Blvd
Fremont, CA 94538-4375
Phone (510) 252-6810

Other identifiers 2

IdentifierTypeStateIssuer
550003720OtherLICENSE #
1780054379MedicaidCA

Other names 1

  • Bay Area Community Health Irvington Dave Clinic II Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190305002310 CA Part A Provider - Federally Qualified Health Center (FQHC) 1658349824 Practice locations: Fremont, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245719129. Details of each certification follow.

Federally qualified health center certification: CCN 921115

Legal name
BAY AREA COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 2019
Last certification
Feb 6, 2019
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Dec 6, 1972 in CA
Enrollment address
40924 Fremont Blvd
Fremont, CA 94538-4375

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
Tri City Family Plannin32 organizations share this tax ID, including this one
Part of
Tri City Family Plannin

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Marvin L Wong Individual Corporate DirectorBoard Member Nov 15, 2018
Kobin Lee Individual Corporate DirectorVice Chair / Board Member Nov 15, 2018
Zettie D Page Individual Corporate DirectorCeo Nov 15, 2018
W-2 Managing EmployeeAuthorized Official Nov 15, 2018
Sherland D Headley Individual Corporate Director Nov 15, 2018
Xianzhong Zhu Individual Corporate DirectorSecretary Nov 15, 2018
Brenda L Quillin Individual Corporate DirectorBoard Member Nov 15, 2018
Stephanie J Reddell Individual Corporate DirectorBoard Member Nov 15, 2018
Ana Robledo Individual Corporate Officer Aug 8, 2024
Robert J Wyckoff Individual Corporate DirectorChair Board Member Nov 15, 2018

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Gilroy Health ClinicGilroy, CA, CCN 751868 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Bach Family ClinicSan Jose, CA, CCN 751182 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 1, 2020
Nov 15, 2018
Monterey Plaza Health ClinicSan Jose, CA, CCN 751869 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Mt. Pleasant School Based ClinicSan Jose, CA, CCN 751867 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020

Owned or controlled facilities with NPI records 4

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

  • Bay Area Community Health

    dba Monterey Plaza Health Clinic

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1598387680

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba Mt. Pleasant Health Center

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1659993699

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba Bay Area Community Health Center Of Gilroy

    • Federally Qualified Health Center (FQHC)
    • Gilroy, CA
    • NPI 1871115964

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba BACH Family Clinic

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1962024059

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

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": "1533859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1245719129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40910 FREMONT BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945384375",
            "telephone_number": "510-252-6810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40924 FREMONT BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945384375",
            "telephone_number": "510-252-6810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAY AREA COMMUNITY HEALTH",
        "enumeration_date": "2018-08-10",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "SHETH",
        "authorized_official_first_name": "JAGAT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "510-252-6810",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "550003720",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1780054379",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bay Area Community Health Irvington Dave Clinic II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, CA

Sources for this page

Verify at the official NPI Registry.