NPIMap

Organization Active NPI

Elica Health Centers

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1265059182
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ELICA HEALTH CENTERS
Practice address
77 Cadillac Dr Ste 200
Sacramento, CA 95825-8337
Phone
(916) 454-2345
Fax
(916) 890-3828
NPI assigned
Jun 26, 2020
Last updated
Mar 8, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
ELICA HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Authorized official

Name
Tatyana Bak
Title
Ceo
Phone
(916) 569-8484

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

77 Cadillac Dr Ste 200
Sacramento, CA 95825-8337

Mailing address

1860 Howe Ave Ste 440
Sacramento, CA 95825-1098
Phone (916) 569-8484

Other names 1

  • Elica Health Centers - Cadillac Drive Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090818000598 CA Part B Supplier - Clinic/Group Practice 4385706845 Receives reassigned benefits from 105 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; West Sacramento, CA; North Highlands, CA

Other NPIs on the same Medicare enrollment 15

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

View all 15

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
05D2189802Elica Health Centers - Cadillac Drive77 Cadillac Dr Suite 200, Sacramento, CA 95825Certificate of waiverAug 4, 2026

National Provider Directory

National Provider Directory
Tax ID family
Elica Health Centers10 organizations share this tax ID, including this one
Part of
Elica Health Centers

Other organizations with this tax ID 9

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

Locations

1276 Halyard Dr
West Sacramento, CA 95691
Phone (530) 865-5544

Practitioners & affiliated clinicians

Practitioners 4

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": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1265059182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 HOWE AVE STE 440",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958251098",
            "telephone_number": "916-569-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 CADILLAC DR STE 200",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958258337",
            "telephone_number": "916-454-2345",
            "fax_number": "916-890-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELICA HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELICA HEALTH CENTERS",
        "enumeration_date": "2020-06-26",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "BAK",
        "authorized_official_first_name": "TATYANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-569-8484"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elica Health Centers - Cadillac Drive",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Elica Health Centers - Cadillac Drive",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2022; 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.