NPIMap

Organization Active NPI

Axis Community Health Inc

  • Federally Qualified Health Center (FQHC)
  • Livermore, CA
National Provider Identifier
1306877121
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
A0610721 Issued in CA
Legal business name
AXIS COMMUNITY HEALTH INC
Practice address
3311 Pacific Ave
Livermore, CA 94551
Phone
(925) 462-1755
Fax
(925) 417-1503
NPI assigned
Jul 6, 2006
Last updated
Sep 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Authorized official

Name
Elizabeth Perez-Howe
Title
Ceo
Phone
(925) 462-1755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X A0610721 CA Primary

Addresses

Primary practice location

3311 Pacific Ave
Livermore, CA 94551

Mailing address

5925 W Las Positas Blvd Ste 100
Pleasanton, CA 94588-8537
Phone (925) 462-1755

Other identifiers 1

IdentifierTypeStateIssuer
FHC70205FMedicaidCA

Other names 1

  • AXIS COMMUNITY HEALTH Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110513000504 CA Part A Provider - Federally Qualified Health Center (FQHC) 7012975071 Practice locations: Livermore, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306877121. Details of each certification follow.

Federally qualified health center certification: CCN 551090

Legal name
AXIS COMMUNITY HEALTH INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 13, 2011
Last certification
May 13, 2011
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Enrollment address
3311 Pacific Ave
Livermore, CA 94550-7007

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Axis Community Health9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

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
Yolanda Brown Individual Corporate Director Mar 23, 2011
Thelma Fones Individual Corporate Director Mar 23, 2011
Mark Eaton Individual Corporate Director Mar 23, 2011
James Paxson Individual Corporate Director Mar 23, 2011
Brendan East Individual Corporate Director Mar 1, 2014
Farzana Najeeb Individual Corporate Director Mar 23, 2011
Gladys Montalvo-Campo Individual Corporate Director Mar 23, 2011
Yolanda Santillan Arias Individual Corporate Director Mar 23, 2011
Elizabeth Perez-Howe Individual Corporate OfficerCeo Jun 4, 2022
Michael Mandelkow Individual Corporate Officer Feb 11, 2019
Operational/Managerial Control Feb 11, 2019

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Axis Community HealthPleasanton, CA, CCN 551018 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 22, 1972
Axis Community HealthPleasanton, CA, CCN 751866 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 22, 1972
Axis Community HealthLivermore, CA, CCN A11022 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 22, 1972

Owned or controlled facilities with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1306877121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5925 W LAS POSITAS BLVD STE 100",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945888537",
            "telephone_number": "925-462-1755",
            "fax_number": "925-417-1503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3311 PACIFIC AVE",
            "city": "LIVERMORE",
            "state": "CA",
            "postal_code": "94551",
            "telephone_number": "925-462-1755",
            "fax_number": "925-417-1503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS COMMUNITY HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "PEREZ-HOWE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "925-462-1755"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "A0610721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70205F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AXIS COMMUNITY HEALTH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Livermore, CA

Sources for this page

Verify at the official NPI Registry.