Active NPI
Ole Health
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- OLE HEALTH
- Practice address
- 1101 B Gale Wilson Blvd Ste 101C
Fairfield, CA 94533-3771 - Phone
- (707) 254-1770
- NPI assigned
- Sep 4, 2018
- Last updated
- Nov 15, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Alicia Hardy
- Title
- Executive Chief Officer
- Phone
- (707) 254-1774
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | CA | Primary |
Addresses
Primary practice location
1101 B Gale Wilson Blvd Ste 101C
Fairfield, CA 94533-3771
Mailing address
1141 Pear Tree LN Ste 100
Napa, CA 94558-6485
Phone (707) 254-1770
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040427001735 | CA | Part B Supplier - Clinic/Group Practice | 7315934767 |
Receives reassigned benefits from 134 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Napa, CA; Saint Helena, CA; Fairfield, CA; Calistoga, CA; American Canyon, CA |
| O20200421001314 | CA | Part A Provider - Federally Qualified Health Center (FQHC) | 7315934767 | Practice locations: Fairfield, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1316429558. Details of each certification follow.
Federally qualified health center certification: CCN 921815
- Legal name
- OLE HEALTH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 28, 2020
- Last certification
- Mar 28, 2020
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation
- Incorporated
- Oct 19, 1972 in CA
- Enrollment address
- 1101 B Gale Wilson Blvd
Ste 101C
Fairfield, CA 94533-3771
Other NPIs with the same Medicare PAC ID 12
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- Davis, CA
- NPI 1558366823
7315934767
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- Woodland, CA
- NPI 1558469064
7315934767
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
- NPI 1710087515
7315934767
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
- NPI 1881330579
7315934767
Other NPIs on the same Medicare enrollment 10
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Federally Qualified Health Center (FQHC)
- American Canyon, CA
- NPI 1508573379
O20040427001735
National Provider Directory
National Provider Directory- Tax ID family
- Ole Health
Other organizations with this tax ID 21
Organizations that report the same tax identification number in the National Provider Directory.
-
dba CommuniCare OLE
- Adolescent and Children Mental Health Clinic/Center
- Woodland, CA
- NPI 1073006607
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
- NPI 1144687955
-
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
- NPI 1245043165
-
- Federally Qualified Health Center (FQHC)
- Napa, CA
- NPI 1275257826
-
dba CommuniCare Family Wellness Center - Unity Building
- Community/Behavioral Health Agency
- Woodland, CA
- NPI 1366091191
-
- Federally Qualified Health Center (FQHC)
- Napa, CA
- NPI 1447687330
-
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
- NPI 1497130280
-
- Federally Qualified Health Center (FQHC)
- American Canyon, CA
- NPI 1508573379
Locations
1101 B Gale Wilson Blvd
Ste 101C
Fairfield, CA 94533
Phone (707) 419-8990
470 Chadbourne Rd
Ste A
Fairfield, CA 94534
Phone (707) 419-8989
Ownership & related parties
All disclosed owners & managing parties 14
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Peter Richmond | Corporate Director | Jul 25, 2017 | |
| Madeline Hernandez | Corporate Director | Apr 23, 2019 | |
| Deborah Goodin | Corporate Director | Mar 11, 2022 | |
| Exa Johanna Moore | Corporate Director | Nov 23, 2004 | |
| Beatrice Labastida | Corporate Director | Dec 22, 2015 | |
| Arthur Roosa | Corporate Director | Apr 23, 2019 | |
| Patricia McFarland | Corporate Director | Dec 6, 2016 | |
| Monin Martin | Corporate Director | Oct 14, 2019 | |
| Cephas Mugerwa | Corporate Director | Mar 11, 2022 | |
| Andrew Torge | Corporate Officer | Jun 19, 2017 | |
| Ole Health | Operational/Managerial Control | Sep 14, 2018 | 100% |
| Bryan Nazario | Corporate Director | Mar 11, 2022 | |
| Rosemarie Bautista Macisaac | Corporate Officer | Jun 5, 2023 | |
| Alicia F Hardy | Corporate Officer | Jan 9, 2018 | |
| W-2 Managing Employee | Mar 2, 2009 |
Owners & managing parties with NPI records 12
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
- NPI 1245043165
Operational/Managerial Control
-
- Federally Qualified Health Center (FQHC)
- Saint Helena, CA
- NPI 1295913366
Operational/Managerial Control
-
- Federally Qualified Health Center (FQHC)
- Napa, CA
- NPI 1447687330
Operational/Managerial Control
-
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
- NPI 1497130280
Operational/Managerial Control
-
- Federally Qualified Health Center (FQHC)
- American Canyon, CA
- NPI 1508573379
Operational/Managerial Control
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- Davis, CA
- NPI 1558366823
Operational/Managerial Control
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- Woodland, CA
- NPI 1558469064
Operational/Managerial Control
-
- Federally Qualified Health Center (FQHC)
- Napa, CA
- NPI 1700976503
Operational/Managerial Control
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
- NPI 1710087515
Operational/Managerial Control
-
- Federally Qualified Health Center (FQHC)
- Calistoga, CA
- NPI 1760660831
Operational/Managerial Control
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
- NPI 1881330579
Operational/Managerial Control
-
- Federally Qualified Health Center (FQHC)
- Napa, CA
- NPI 1902106198
Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 6
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.
-
- Clinical Social Worker
- Napa, CA
- NPI 1194908475
-
- Physician Assistant
- Napa, CA
- NPI 1053045963
-
- Family Nurse Practitioner
- Fairfield, CA
- NPI 1821640616
-
- Family Medicine Physician
- Fairfield, CA
- NPI 1689013195
-
- Clinical Social Worker
- Fairfield, CA
- NPI 1689112229
-
- Family Medicine Physician
- Napa, CA
- NPI 1558378984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536019200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1573776000000",
"number": "1316429558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1141 PEAR TREE LN STE 100",
"city": "NAPA",
"state": "CA",
"postal_code": "945586485",
"telephone_number": "707-254-1770",
"fax_number": "707-254-1779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 B GALE WILSON BLVD STE 101C",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945333771",
"telephone_number": "707-254-1770"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OLE HEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2018-09-04",
"last_updated": "2019-11-15",
"status": "A",
"authorized_official_last_name": "HARDY",
"authorized_official_first_name": "ALICIA",
"authorized_official_title_or_position": "EXECUTIVE CHIEF OFFICER",
"authorized_official_telephone_number": "707-254-1774"
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.