NPIMap

Organization Active NPI

M a C T Health Board, Incorporated

Doing business as MACT Medical San Andreas

  • Clinic/Center
  • San Andreas, CA
National Provider Identifier
1346410255
Registry record updated Jun 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
550000678 Issued in CA
Legal business name
M A C T HEALTH BOARD, INCORPORATED
Doing business as
MACT Medical San Andreas
Practice address
1113 Hwy 49
San Andreas, CA 95249-9583
Phone
(209) 755-1400
Fax
(209) 755-1430
NPI assigned
Mar 6, 2008
Last updated
Jun 12, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
MACT HEALTH BOARD, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Authorized official

Name
Mr. John Alexander
Title
Executive Director
Phone
(209) 754-6262

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 550000678 CA Primary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Rural Health Clinic/Center 261QR1300X CA
Community Health Worker 172V00000X NU
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

1113 Hwy 49
San Andreas, CA 95249-9583

Mailing address

PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6262

Other names 1

  • MACT Medical San Andreas Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090212000720 TX Part A Provider - Federally Qualified Health Center (FQHC) 8325936974 1 other NPI on this enrollment
Practice locations: San Andreas, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346410255. Details of each certification follow.

Federally qualified health center certification: CCN 051153

Legal name
M A C T HEALTH BOARD INCORPORATED
Doing business as
MACT HEALTH BOARD INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 17, 2009
Last certification
Mar 17, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 25, 1979 in CA
Enrollment address
1113 Highway 49
San Andreas, CA 95249-9583

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1084391Mact Medical San Andreas1113 Hwy 49, San Andreas, CA 95249Certificate of waiverMay 20, 2028

National Provider Directory

National Provider Directory
Part of
Mact Health Board Incorporated

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
John Alexander Individual Corporate DirectorExecutive Director Nov 1, 2012 16.6%
W-2 Managing EmployeeExecutive Director Nov 1, 2012
Justin Baugh Individual Corporate OfficerBoard Chairman Jun 2, 2017
George Gurion Individual Corporate OfficerBoard Vice Chair Apr 22, 2023
Carolyn Sayers Individual Corporate OfficerBoard Secretary Jun 3, 2025
Mariela Contreras Individual Corporate OfficerFinance /Executive Deputy Direct Jul 25, 2015
Corporate DirectorFinance /Executive Deputy Direct Jul 25, 2015
Nancy Ehlers Individual Corporate OfficerBoard Treasurer Jan 21, 2019
M a C T Health Board Incorporated Organization, Angels Camp, CA Non-profit Operational/Managerial Control Apr 16, 2007 100%

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
M a C T Health Board IncorporatedMariposa, CA, CCN 921022 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 27, 1999
M a C T Health Board IncorporatedJackson, CA, CCN 921021 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2016
M a C T Health Board IncorporatedSonora, CA, CCN 751981 Federally qualified health center Operational/Managerial Control (100%) Apr 16, 2007
Mact Medical, IoneIone, CA, CCN A01054 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2021
Mact Health & WellnessSonora, CA, CCN A01099 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 8, 2022
Mact Women's Health CenterSonoro, CA, CCN A01832 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedValley Springs, CA, CCN A01937 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedSonora, CA, CCN A01981 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedSutter Creek, CA, CCN A11044 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedSonora, CA, CCN A11039 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedSonora, CA, CCN A11038 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979
M a C T Health Board IncorporatedBear Valley, CA, CCN A11052 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 21, 1979

Owned or controlled facilities with NPI records 11

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1204761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1346410255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939",
            "telephone_number": "209-754-6262",
            "fax_number": "209-754-6274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 HWY 49",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499583",
            "telephone_number": "209-755-1400",
            "fax_number": "209-755-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M A C T HEALTH BOARD, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MACT HEALTH BOARD, INC.",
        "enumeration_date": "2008-03-06",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-754-6262",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "550000678",
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MACT Medical San Andreas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Andreas, CA

Sources for this page

Verify at the official NPI Registry.