NPIMap

Organization Active NPI

San Benito Health Foundation

  • Rural Health Clinic/Center
  • Hollister, CA
National Provider Identifier
1295810174
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAN BENITO HEALTH FOUNDATION
Practice address
351 Felice Dr
Hollister, CA 95023-3361
Phone
(831) 637-5306
Fax
(831) 637-9640
NPI assigned
Oct 26, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Rosa Vivian Fernandez, MPH
Title
Executive Director
Phone
(831) 637-5306

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

351 Felice Dr
Hollister, CA 95023-3361

Mailing address

351 Felice Dr
Hollister, CA 95023-3361
Phone (831) 637-5306

Other identifiers 4

IdentifierTypeStateIssuer
FHC03872FOtherCAMEDI-CAL IDENTIFIER
HAP03872FMedicaidCA
BCP03872FMedicaidCA
EAP03872FOtherCAUNCOMPENSATED CARE

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031205000584 CA Part B Supplier - Clinic/Group Practice 0840195442 Receives reassigned benefits from 14 practitioners
Practice locations: Hollister, CA
O20100901000499 CA Part A Provider - Federally Qualified Health Center (FQHC) 0840195442 Practice locations: Hollister, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295810174. Details of each certification follow.

Federally qualified health center certification: CCN 551841

Legal name
SAN BENITO HEALTH FOUNDATION
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 16, 1997
Last certification
Jun 16, 1997
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 20, 1975 in CA
Enrollment address
351 Felice Dr
Hollister, CA 95023-3361

National Provider Directory

National Provider Directory

Locations

351 Felice Dr
Hollister, CA 95023
Phone (831) 634-2123

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Robert Lund Individual Corporate Director Jun 1, 2013
Laura V Stampleman Individual Corporate Director Aug 1, 2018
Rosa Fernandez Individual Corporate OfficerPresident & Ceo Jul 12, 2004 10%
W-2 Managing Employee Jun 30, 2010 10%
Arcadio Viveros Individual Corporate Director Feb 1, 2013
Victoria Montoya Individual Corporate Director Jun 30, 2010
Luis a Diaz Individual Corporate Director Jun 1, 2013
Michael Reid Individual Corporate Director Jun 30, 2021
Bonita Villalobos-Rivera Individual Corporate DirectorBoard Member May 1, 2010
Art Testani Individual Corporate Director Jul 1, 2019
Yolanda Lopez Individual Corporate Director May 28, 2020

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295810174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 FELICE DR",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950233361",
            "telephone_number": "831-637-5306",
            "fax_number": "831-637-9640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 FELICE DR",
            "city": "HOLLISTER",
            "state": "CA",
            "postal_code": "950233361",
            "telephone_number": "831-637-5306",
            "fax_number": "831-637-9640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN BENITO HEALTH FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "ROSA",
        "authorized_official_middle_name": "VIVIAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "831-637-5306",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL IDENTIFIER",
            "identifier": "FHC03872F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP03872F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP03872F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNCOMPENSATED CARE",
            "identifier": "EAP03872F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollister, CA

Sources for this page

Verify at the official NPI Registry.