NPIMap

Centro de Salud de la Comunidad de San Ysidro Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · San Diego, CA

NPI 1326225632 · NPPES record last updated Nov 6, 2019

Key facts

NPI
1326225632
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
090000143 (CA)
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO INC
Practice address
3177 Ocean View Blvd
San Diego, CA 92113-1432
Phone
(619) 662-4100
Fax
(619) 428-7952
NPI assigned
Jan 29, 2008
Organization subpart
No

Authorized official

Name
Kevin Mattson
Title
President/Ceo
Phone
(619) 662-4100

Owners & managing parties with NPI records 1

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

Other NPIs on the same Medicare enrollment 40

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

View all 40

Corporate family (same tax ID) 24

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

Facilities with the same owner 5

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

Practitioners 20

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 (3 enrollments) in CA

Federally qualified health center certification: CCN 551920

Legal name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
SAN YSIDRO HEALTH CHC-OCEAN VIEW
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 10, 2003
Last certification
Jan 10, 2003
Ownership / control type
For profit – corporation
Most recent change of ownership
Aug 25, 2008 (1 total)
Organization structure
Corporation · Non-profit
Incorporated
Feb 5, 1971 in CA
Enrollment address
3177 Ocean View Blvd
San Diego, CA 92113-1432

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.

NameRoleSinceShare
Tomas Urtasun
Individual 		Corporate Director
Board Member		 Apr 1, 2010
Guillermo Gomez
Individual 		Corporate Director
Board Member		 Oct 20, 2012
Magdalena Peraza
Individual 		Corporate Director Aug 25, 2008
William Wallace
Individual 		Corporate Officer
Cfo		 Nov 1, 2019
Victor Nieto
Individual 		Corporate Director Aug 25, 2008
Reynaldo Perez
Individual 		Corporate Director Aug 25, 2008
Antonietta McGuirk
Individual 		Corporate Director
Director of Revenue Cycle		 Oct 16, 2013
Terry Whitaker
Individual 		Corporate Director Aug 25, 2008
Centro de Salud de la Comunidad de San Ysidro, Inc.
Organization · San Diego, CA 		5% Or Greater Direct Ownership Interest Aug 25, 2008
Sergio Cuevas
Individual 		W-2 Managing Employee Aug 25, 2008
Gloria Ramirez
Individual 		Corporate Director Aug 25, 2008
Macario Gutierrez
Individual 		Corporate Director Aug 25, 2008
Kevin Mattson
Individual 		Corporate Director Aug 25, 2008
Margarita Navarro
Individual 		Corporate Director Aug 25, 2008

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
San Ysidro Health Euclid
San Diego, CA · CCN 551922		 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2009
San Ysidro Health Otay
Chula Vista, CA · CCN 551966		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 5, 1971
San Ysidro Health San Diego Pace/Senior Health Services
San Ysidro, CA · CCN 751102		 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2014
San Ysidro Health El Cajon/San Diego Pace
El Cajon, CA · CCN 751822		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2015
San Ysidro Health South Bay
National City, CA · CCN 751950		 Federally qualified health center 5% Or Greater Direct Ownership Interest (5%) Jun 1, 2016

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040130000711 CA Part B Supplier - Clinic/Group Practice 6901709435 Receives reassigned benefits from 611 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: National City, CA; San Diego, CA; San Ysidro, CA; Santee, CA; Vista, CA; Alpine, CA; Campo, CA; Chula Vista, CA…
O20081021000272 CA Part a Provider - Federally Qualified Health Center (FQHC) 6901709435 Practice locations: San Diego, CA
O20191023003400 CA MDPP Supplier - in-Person MDPP Supplier 6901709435 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Diego, CA; San Ysidro, CA; National City, CA; Chula Vista, CA

National Provider Directory

Tax ID family
Centro de Salud de la Comun (51 organizations share this tax ID)

Locations

1855 1st Ave
San Diego, CA 92101
Phone (619) 235-4211

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 090000143 CA Yes

Addresses

Primary practice location

3177 Ocean View Blvd
San Diego, CA 92113-1432

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 662-4100

Other identifiers

IdentifierTypeStateIssuer
W5740OtherCAMEDICARE PART B PTAN
FHC11998GMedicaidCA

Other names

  • San Ysidro Health CHC-Ocean View Doing business as

Other providers in San Diego, CA

All providers in San Diego, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.