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San Benito Health Foundation

Organization Active NPI Rural Health Clinic/Center · Hollister, CA

NPI 1295810174 · NPPES record last updated Aug 22, 2020

Key facts

NPI
1295810174
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 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
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 1

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

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

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
Corporation · Non-profit
Incorporated
May 20, 1975 in CA
Enrollment address
351 Felice Dr
Hollister, CA 95023-3361

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 Officer
President & 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 Director
Board Member		 May 1, 2010
Art Testani
Individual 		Corporate Director Jul 1, 2019
Yolanda Lopez
Individual 		Corporate Director May 28, 2020

Medicare enrollment records

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

National Provider Directory

Locations

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

Specialties & licenses

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

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

IdentifierTypeStateIssuer
HAP03872FMedicaidCA
EAP03872FOtherCAUNCOMPENSATED CARE
BCP03872FMedicaidCA
FHC03872FOtherCAMEDI-CAL IDENTIFIER

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 22, 2020.

{
    "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": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP03872F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNCOMPENSATED CARE",
            "identifier": "EAP03872F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP03872F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL IDENTIFIER",
            "identifier": "FHC03872F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollister, CA

All providers in Hollister, CA · Rural Health Clinic/Center in California

Sources for this page

Verify at the official NPI Registry.