NPIMap

Organization Active NPI

Indian Health Center of Santa Clara Valley

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1275964488
Registry record updated Jan 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
070000118 Issued in CA
Legal business name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Practice address
1118 Meridian Ave Ste 150
San Jose, CA 95125-4329
Phone
(408) 445-3400
NPI assigned
Dec 13, 2013
Last updated
Jan 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2025

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

Authorized official

Name
Dr. Aldon Wayne Scott, DM
Title
Director of Operations
Phone
(408) 445-3400

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 070000118 CA Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 070000482 CA
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

1118 Meridian Ave Ste 150
San Jose, CA 95125-4329

Mailing address

1333 Meridian Ave
San Jose, CA 95125-5212
Phone (408) 445-3400

Other practice location 1

1685 Westwood Dr Ste 1
San Jose, CA 95125
Phone (408) 445-3400

Other identifiers 1

IdentifierTypeStateIssuer
FHC11833FMedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120126000250 CA Part B Supplier - Clinic/Group Practice 1153406665 Receives reassigned benefits from 94 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Jose, CA
O20140804001912 CA Part A Provider - Federally Qualified Health Center (FQHC) 1153406665 Practice locations: San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275964488. Details of each certification follow.

Federally qualified health center certification: CCN 751120

Legal name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 12, 2014
Last certification
Aug 12, 2014
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 16, 1977 in CA
Enrollment address
1118 Meridian Ave
Ste 150
San Jose, CA 95125-4329

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Indian HLTH Ctr of Sant14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

1118 Meridian Ave
San Jose, CA 95125
Phone (408) 445-8172

1118 Meridian Ave
Ste 150
San Jose, CA 95125
Phone (408) 445-8172

1685 Westwood Dr
Ste 1
San Jose, CA 95125

25 N 14th St
Ste 130
San Jose, CA 95112
Phone 40844534003730

602 E Santa Clara St
San Jose, CA 95112
Phone 4084453400 ext. 333

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
Indian Health Center of Santa Clara Valley Organization, San Jose, CA Operational/Managerial Control Jun 12, 2014
Ira Singh Individual Corporate OfficerChief Operation Officer Aug 17, 2015
W-2 Managing EmployeeChief Operation Officer Aug 17, 2015
Operational/Managerial ControlChief Operation Officer Aug 17, 2015
Aldon W Scott Individual W-2 Managing EmployeeDirector of Operations Jan 17, 2006
Operational/Managerial ControlDirector of Operations Jan 17, 2006
Sonya M Tetnowski Individual Corporate OfficerChief Executive Officer Jun 30, 2014
W-2 Managing EmployeeChief Executive Officer Jun 30, 2014
Operational/Managerial ControlChief Executive Officer Jan 28, 2004
Pablo D Viramontes Individual Corporate DirectorBoard of Director Aug 2, 2005
Paulette T Pico Individual Corporate DirectorBoard of Director Jun 27, 2016
Patrick Brien Individual Corporate DirectorBoard of Director Aug 24, 2022
Lisa Aguirre Individual Corporate DirectorBoard of Director Sep 1, 2019
Soma de Bourbon Individual Corporate DirectorBoard of Director Jan 1, 2022
Charlene Eigen-Vasquez Individual Corporate DirectorBoard of Director Nov 1, 2019
Rene Samayoa Individual Corporate DirectorBoard Member Aug 1, 2022

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Indian Health Center of Santa Clara ValleySan Jose, CA, CCN 551120 Federally qualified health center Operational/Managerial Control Jan 28, 2004

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 96

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 96

NPI Registry JSON

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

{
    "created_epoch": "1386892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738195200000",
    "number": "1275964488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MERIDIAN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255212",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 MERIDIAN AVE STE 150",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951254329",
            "telephone_number": "408-445-3400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1685 Westwood Dr Ste 1",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "95125",
            "country_code": "US",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-13",
        "last_updated": "2025-01-30",
        "certification_date": "2025-01-30",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "ALDON",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "408-445-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DM"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "070000118",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "070000482",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11833F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.