NPIMap

Organization Active NPI

M a C T Health Board Incorporated

Doing business as MACT Medical Jackson

  • Clinic/Center
  • Jackson, CA
National Provider Identifier
1295727287
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
M A C T HEALTH BOARD INCORPORATED
Doing business as
MACT Medical Jackson
Practice address
12140/12150 New York Ranch Rd
Jackson, CA 95642-9407
Phone
(209) 257-2400
Fax
(209) 257-2403
NPI assigned
Aug 17, 2005
Last updated
Jun 12, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MACT HEALTH BOARD INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Authorized official

Name
Mr. John Alexander
Title
Executive Director
Phone
(209) 754-6262

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Community Health WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 172V00000X
Clinic/Center 261Q00000X Primary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

12140/12150 New York Ranch Rd
Jackson, CA 95642-9407

Mailing address

PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6262

Other identifiers 1

IdentifierTypeStateIssuer
THP70776FMedicaidCA

Other names 1

  • MACT Medical Jackson Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170324000662 CA Part A Provider - Federally Qualified Health Center (FQHC) 8325936974 1 other NPI on this enrollment
Practice locations: Jackson, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295727287. Details of each certification follow.

Federally qualified health center certification: CCN 921021

Legal name
M A C T HEALTH BOARD INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 5, 2017
Last certification
Dec 5, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 21, 1979 in CA
Enrollment address
12140 New York Ranch Rd
Jackson, CA 95642-9407

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
M a C T Health Board Inc

Locations

19177 State Highway 120
Groveland, CA 95321
Phone (209) 754-6262

305 Preston Ave
Ione, CA 95640
Phone (209) 274-2183

13975 Mono Way
Ste I
Sonora, CA 95370
Phone (209) 533-9603

905 Morning Star Dr
Sonora, CA 95370
Phone (209) 533-9600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Justin Baugh Individual Corporate OfficerBoard Chair Jun 2, 2017
George Gurion Individual Corporate OfficerBoard Vice Chair Apr 22, 2023
Carolyn Sayers Individual Corporate OfficerBoard Secretary Jun 3, 2025
Mariela Contreras Individual Corporate DirectorExecutive Director May 6, 2026
W-2 Managing EmployeeExecutive Director Jul 25, 2015
Nancy Ehlers Individual Corporate OfficerBoard Treasurer Jan 21, 2019
M a C T Health Board Incorporated Organization, Angels Camp, CA Non-profit Operational/Managerial Control Nov 1, 2016 100%

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
Mact Health Board IncSan Andreas, CA, CCN 051153 Federally qualified health center Operational/Managerial Control (100%) Apr 16, 2007
M a C T Health Board IncorporatedMariposa, CA, CCN 921022 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 27, 1999
M a C T Health Board IncorporatedSonora, CA, CCN 751981 Federally qualified health center Operational/Managerial Control (100%) Apr 16, 2007
Mact Medical, IoneIone, CA, CCN A01054 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Mact Health & WellnessSonora, CA, CCN A01099 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 8, 2022
Mact Women's Health CenterSonoro, CA, CCN A01832 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedValley Springs, CA, CCN A01937 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedSonora, CA, CCN A01981 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedSutter Creek, CA, CCN A11044 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedSonora, CA, CCN A11039 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedSonora, CA, CCN A11038 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedBear Valley, CA, CCN A11052 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979

Owned or controlled facilities with NPI records 11

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1295727287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939",
            "telephone_number": "209-754-6262",
            "fax_number": "209-754-6274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12140/12150 NEW YORK RANCH RD",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956429407",
            "telephone_number": "209-257-2400",
            "fax_number": "209-257-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M A C T HEALTH BOARD INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MACT HEALTH BOARD INCORPORATED",
        "enumeration_date": "2005-08-17",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-754-6262",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "THP70776F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MACT Medical Jackson",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, CA

Sources for this page

Verify at the official NPI Registry.