NPIMap

Organization Active NPI

Indian Health Center of Santa Clara Valley

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1326425265
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
70000482 Issued in CA
Legal business name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Practice address
2030 Forest Ave Ste 110
San Jose, CA 95128-4833
Phone
(408) 445-3400
NPI assigned
Apr 29, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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

Authorized official

Name
Mr. Aldon Wayne Scott, DM
Title
Director of Operations
Phone
(408) 445-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 70000482 CA Primary

Addresses

Primary practice location

2030 Forest Ave Ste 110
San Jose, CA 95128-4833

Mailing address

1333 Meridian Ave
San Jose, CA 95125-5212
Phone (408) 445-3400

Other identifiers 4

IdentifierTypeStateIssuer
FHC11833FOtherCASTATE PROGRAMS
G01133-01OtherCADELTA DENTAL
55-1120OtherCAMEDICARE PALMETTO
FHC11833FMedicaidCA

Other names 1

  • Indian Health Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120126000250 CA Part B Supplier - Clinic/Group Practice 1153406665 Receives reassigned benefits from 94 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Jose, CA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1430265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490140800000",
    "number": "1326425265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MERIDIAN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255212",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 FOREST AVE STE 110",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951284833",
            "telephone_number": "408-445-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-29",
        "last_updated": "2017-03-22",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "ALDON",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "408-445-3400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DM"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "70000482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROGRAMS",
            "identifier": "FHC11833F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "G01133-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PALMETTO",
            "identifier": "55-1120",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11833F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.