Family Health Center of Joshua Tree, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FAMILY HEALTH CENTER OF JOSHUA TREE, INC.

Practice address

57445 29 Palms Hwy Ste 302
Yucca Valley, CA 92284-2947

Phone

(760) 366-7555

Fax

(760) 366-0529

NPI assigned

Nov 14, 2007

Last updated

Aug 13, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Virginia Moore

Title

Administrative Assistant

Phone

(530) 340-5406

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255511630. Details of each certification follow.

• CCN 058941 Rural health clinic · Active · Details

Rural health clinic certification: CCN 058941

Legal name

FAMILY HEALTH CENTER OF JOSHUA TREE, INC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 4, 2009

Last certification

Mar 25, 2015

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Jun 6, 2007 in CA

Enrollment address

57445 29 Palms Hwy
Ste 302
Yucca Valley, CA 92284-2947

Other NPIs with the same Medicare PAC ID 1

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

• High Desert Family Medical Clinic

  • Family Medicine Physician
  • Yucca Valley, CA
  • NPI 1639405004

  0648346007

  Same PAC ID

Tax ID family

High Desert Family Medical Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Hi-Desert Family Medical Clinic

  • Rural Health Clinic/Center
  • Yucca Valley, CA
  • NPI 1427595412
  NPD tax ID
• High Desert Family Medical Clinic

  • Family Medicine Physician
  • Yucca Valley, CA
  • NPI 1639405004
  NPD tax ID

Locations

All disclosed owners & managing parties 1

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

Owners & managing parties with NPI records 1

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

• Andre Martin Kasko, D.O.

  • Gynecology Physician
  • Yucca Valley, CA
  • NPI 1679624191

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Hi-Desert Family Medical Clinic

  • Rural Health Clinic/Center
  • Yucca Valley, CA
  • NPI 1427595412
  NPPES parent name
• High Desert Family Medical Clinic

  • Family Medicine Physician
  • Yucca Valley, CA
  • NPI 1639405004
  NPPES parent name

Practitioners 2

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.

• Andre Martin Kasko, D.O.

  • Gynecology Physician
  • Yucca Valley, CA
  • NPI 1679624191
  NPD (past)
• Lisa Brown, FNP-BC

  • Family Nurse Practitioner
  • Hagerstown, MD
  • NPI 1821558164
  NPD (past)

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755043200000",
    "number": "1255511630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1220",
            "city": "JOSHUA TREE",
            "state": "CA",
            "postal_code": "922520810",
            "telephone_number": "760-366-7555",
            "fax_number": "760-366-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57445 29 PALMS HWY STE 302",
            "city": "YUCCA VALLEY",
            "state": "CA",
            "postal_code": "922842947",
            "telephone_number": "760-366-7555",
            "fax_number": "760-366-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTER OF JOSHUA TREE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "530-340-5406"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "200A6300",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4630338",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carol Lee Erickson, ACA
• Erwin C Demiany MD Inc
• Yvonne Espinoza
• Robert Stephen Evans, MD
• Faith Home Healthcare Inc
• William Faulkner
• Cory Ferguson, PA-C
• John Fernstrom
• Maira Alejandra Ferrer-Cabrera
• Shawn H. Ferris

• Family Medicine Physician in Yucca Valley, CA
• Providers in Yucca Valley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.