NPIMap

Organization Active NPI

Wellspace Health

  • Federally Qualified Health Center (FQHC)
  • North Highlands, CA
National Provider Identifier
1326175100
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001781 Issued in CA
Legal business name
WELLSPACE HEALTH
Practice address
6015 Watt Ave
Ste 2
North Highlands, CA 95660-4294
Phone
(916) 679-3925
Fax
(916) 679-3928
NPI assigned
Feb 27, 2007
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Dr. Alasdair Jonathan Porteus, PHD
Title
Ceo
Phone
(916) 737-5555

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
ContractorGroup: 193200000X MULTI-SPECIALTY GROUP 171W00000X
Developmentally Disabled Services Day Training Agency 251C00000X
Supports Brokerage Agency 251X00000X
Federally Qualified Health Center (FQHC) 261QF0400X 550001781 CA Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Home Delivered Meals 332U00000X
Personal Care AttendantGroup: 193200000X MULTI-SPECIALTY GROUP 3747P1801X
Respite Care 385H00000X

Addresses

Primary practice location

6015 Watt Ave
Ste 2
North Highlands, CA 95660-4294

Mailing address

1820 J St
Sacramento, CA 95811-3010
Phone (916) 550-5481

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070623000117 CA Part B Supplier - Clinic/Group Practice 8426157975 Receives reassigned benefits from 123 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Jackson, CA; Citrus Heights, CA; Folsom, CA; North Highlands, CA; Roseville, CA
O20100121000667 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426157975 Practice locations: North Highlands, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326175100. Details of each certification follow.

Federally qualified health center certification: CCN 551020

Legal name
WELLSPACE HEALTH
Doing business as
WELLSPACE HEALTH NORTH HIGHLANDS COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 3, 2010
Last certification
Mar 3, 2010
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1970 in CA
Enrollment address
6015 Watt Ave 2-3
North Highlands, CA 95660-4294

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Wellspace Health Professional Health Center for Women42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

Locations

6015 Watt Ave
Ste 2
North Highlands, CA 95660
Phone (916) 368-3080

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Brenda a Shipp Individual Corporate OfficerChief Operations Officer Jun 9, 2014
Operational/Managerial ControlChief Operations Officer Jun 9, 2014
Todd Murray Individual Corporate OfficerFirst Vice President Nov 30, 2017
Chue Vang Individual Corporate OfficerChief Financial Officer Nov 2, 2020
Lisa Stewart Individual Corporate DirectorBoard Consumer Director Jan 1, 2015
Timothy Martin Individual Corporate OfficerBoard Secretary Jul 1, 2021
James Tilton Individual Corporate DirectorBoard President Jan 1, 2015
Jonathan a Porteus Individual Corporate OfficerChief Executive Officer Jan 1, 2011 100%
W-2 Managing Employee Jul 1, 2008
Operational/Managerial Control Jul 21, 2008
Ruzwa Cooper Individual Corporate DirectorBoard Treasurer Jan 1, 2015
Leah Murphy Individual Corporate OfficerSecond Vice President Jan 26, 2021
Jo Ann 'Jody' Gray Individual Corporate DirectorBoard Director Jan 1, 2015
Wellspace Health Organization, Sacramento, CA Non-profit Operational/Managerial Control Nov 27, 2011

Owners & managing parties with NPI records 16

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

View all 16

All facility ownership & control disclosures 10

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

FacilityTypeRoleSince
Wellspace HealthSacramento, CA, CCN 051142 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 551021 Federally qualified health center Operational/Managerial Control Jan 4, 2010
Wellspace HealthSacramento, CA, CCN 551022 Federally qualified health center Operational/Managerial Control May 17, 2010
Wellspace HealthRoseville, CA, CCN 751000 Federally qualified health center Operational/Managerial Control Mar 16, 2012
Wellspace Health Healthcare for Women Community Health CenterSacramento, CA, CCN 921070 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921843 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921842 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921841 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sunrise CommunityCitrus Heights, CA, CCN 921844 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sierra Garden 2Roseville, CA, CCN 921840 Federally qualified health center Operational/Managerial Control Feb 7, 1970

Owned or controlled facilities with NPI records 10

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

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1326175100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 J ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958113010",
            "telephone_number": "916-550-5481",
            "fax_number": "916-822-8974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6015 WATT AVE",
            "address_2": "STE 2",
            "city": "NORTH HIGHLANDS",
            "state": "CA",
            "postal_code": "956604294",
            "telephone_number": "916-679-3925",
            "fax_number": "916-679-3928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPACE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "PORTEUS",
        "authorized_official_first_name": "ALASDAIR",
        "authorized_official_middle_name": "JONATHAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-737-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001781",
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Highlands, CA

Sources for this page

Verify at the official NPI Registry.