M a C T Health Board Incorporated

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

M A C T HEALTH BOARD INCORPORATED

Practice address

1113 Highway 49
San Andreas, CA 95249

Phone

(209) 755-1400

Fax

(209) 755-1430

NPI assigned

Nov 30, 2006

Last updated

Jul 29, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mariela Contreras, MBA

Title

Executive Director

Phone

(209) 754-6262

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, CA16 enrollments

Enrollment records 16

NPI to CCN mapping 14

The Medicare certification numbers (CCNs) connected to NPI 1366519431. Details of each certification follow.

• CCN 051153 Federally qualified health center · Active · Details
• CCN 921022 Federally qualified health center · Active · Details
• CCN 921021 Federally qualified health center · Active · Details
• CCN 751981 Federally qualified health center · Active · Details
• CCN A01054 Federally qualified health center · Active · Details
• CCN A01099 Federally qualified health center · Active · Details
• CCN A01832 Federally qualified health center · Active · Details
• CCN A01937 Federally qualified health center · Active · Details
• CCN A01960 Federally qualified health center · Active · Details
• CCN A01981 Federally qualified health center · Active · Details
• CCN A11044 Federally qualified health center · Active · Details
• CCN A11039 Federally qualified health center · Active · Details
• CCN A11038 Federally qualified health center · Active · Details
• CCN A11052 Federally qualified health center · Active · Details

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

Federally qualified health center certification: CCN 921022

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 31, 2017

Last certification

Oct 31, 2017

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Sep 21, 1979 in CA

Enrollment address

5192 Hospital Rd
Mariposa, CA 95338-9524

Federally qualified health center certification: CCN 921021

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 5, 2017

Last certification

Dec 5, 2017

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Sep 21, 1979 in CA

Enrollment address

12140 New York Ranch Rd
Jackson, CA 95642-9407

Federally qualified health center certification: CCN 751981

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jul 25, 2017

Last certification

Jul 25, 2017

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Sep 21, 1979 in CA

Enrollment address

905 Morning Star Dr
Sonora, CA 95370-9249

Federally qualified health center certification: CCN A01054

Legal name

M A C T HEALTH BOARD INCORPORATED

Doing business as

MACT MEDICAL, IONE

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 11, 2022

Last certification

Feb 11, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Sep 21, 1979 in CA

Enrollment address

305 Preston Ave
Ione, CA 95640-9158

Federally qualified health center certification: CCN A01099

Legal name

M A C T HEALTH BOARD INCORPORATED

Doing business as

MACT HEALTH & WELLNESS

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 19, 2022

Last certification

Aug 19, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

940 Sylva LN
Ste B
Sonora, CA 95370-5969

Federally qualified health center certification: CCN A01832

Legal name

M A C T HEALTH BOARD INCORPORATED

Doing business as

MACT WOMEN'S HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 16, 2024

Last certification

Jan 16, 2024

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Aug 15, 1979 in CA

Enrollment address

13975 Mono Way
Ste G
Sonoro, CA 95370-2824

Federally qualified health center certification: CCN A01937

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Mar 5, 2025

Last certification

Mar 5, 2025

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

1906 Vista del Lago Dr
Ste K
Valley Springs, CA 95252-9700

Federally qualified health center certification: CCN A01960

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 16, 2025

Last certification

May 16, 2025

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

1113A Highway 49
San Andreas, CA 95249

Federally qualified health center certification: CCN A01981

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

May 9, 2025

Last certification

May 9, 2025

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

940 Sylva LN
Ste H
Sonora, CA 95370-5969

Federally qualified health center certification: CCN A11044

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Jan 27, 2026

Last certification

Jan 27, 2026

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

321 Highway 49
Sutter Creek, CA 95685

Federally qualified health center certification: CCN A11039

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 20, 2026

Last certification

Feb 20, 2026

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

940 Sylva LN
Ste a
Sonora, CA 95370-5969

Federally qualified health center certification: CCN A11038

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Oct 29, 2025

Last certification

Oct 29, 2025

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

13975 Mono Way
Ste J
Sonora, CA 95370-2824

Federally qualified health center certification: CCN A11052

Legal name

M A C T HEALTH BOARD INCORPORATED

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 19, 2026

Last certification

Feb 19, 2026

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Enrollment address

367 Creekside Dr
Bear Valley, CA 95223-9455

Other NPIs with the same Medicare PAC ID 5

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

• M a C T Health Board Incorporated

  dba MACT Medical Jackson

  • Clinic/Center
  • Jackson, CA
  • NPI 1295727287

  8325936974

  Same PAC ID
• M a C T Health Board Incorporated

  dba MACT Medical Sonora

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1467444364

  8325936974

  Same PAC ID
• M a C T Health Board, Incorporated

  dba MACT Optometry, Sonora

  • Clinic/Center
  • Sonora, CA
  • NPI 1033898226

  8325936974

  Same PAC ID
• M a C T Health Board, Incorporated

  dba MACT Medical San Andreas

  • Clinic/Center
  • San Andreas, CA
  • NPI 1346410255

  8325936974

  Same PAC ID
• M a C T Health Board, Incorporated

  dba MACT Medical Mariposa

  • Clinic/Center
  • Mariposa, CA
  • NPI 1740272731

  8325936974

  Same PAC ID

Other NPIs on the same Medicare enrollment 12

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

• M a C T Health Board Incorporated

  dba MACT Behavioral Health, Sonora

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1154147445

  O20260511003310

  Same enrollment
• M a C T Health Board Incorporated

  dba MACT Medical Jackson

  • Clinic/Center
  • Jackson, CA
  • NPI 1295727287

  O20170324000662

  Same enrollment
• M a C T Health Board Incorporated

  dba MACT Medical Sonora

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1467444364

  O20170324000920, O20241011001898

  Same enrollment
• M a C T Health Board Incorporated

  dba MACT Behavioral Health, Valley Springs

  • Federally Qualified Health Center (FQHC)
  • Valley Springs, CA
  • NPI 1649091109

  O20250225001527

  Same enrollment
• M a C T Health Board Incorporated

  dba MACT Sonora Women's Health Center

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1871233692

  O20240129002202

  Same enrollment
• M a C T Health Board Incorporated

  dba MACT Sonora Pediatric Health Center

  • Clinic/Center
  • Sonora, CA
  • NPI 1871237040

  O20220824000036

  Same enrollment
• M a C T Health Board, Incorporated

  dba MACT Optometry, Sonora

  • Clinic/Center
  • Sonora, CA
  • NPI 1033898226

  O20250902003184

  Same enrollment
• M a C T Health Board, Incorporated

  dba MACT Medical San Andreas

  • Clinic/Center
  • San Andreas, CA
  • NPI 1346410255

  O20090212000720

  Same enrollment
• M a C T Health Board, Incorporated

  dba MACT Health & Wellness, Sutter Creek

  • Federally Qualified Health Center (FQHC)
  • Sutter Creek, CA
  • NPI 1417741869

  O20260313002713

  Same enrollment
• M a C T Health Board, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Bear Valley, CA
  • NPI 1508724337

  O20260519003010

  Same enrollment
• M a C T Health Board, Incorporated

  • Federally Qualified Health Center (FQHC)
  • San Andreas, CA
  • NPI 1528508488

  O20250818000554

  Same enrollment
• M a C T Health Board, Incorporated

  dba MACT Medical Mariposa

  • Clinic/Center
  • Mariposa, CA
  • NPI 1740272731

  O20170324000163

  Same enrollment

Member of 1

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

• M a C T Health Board, Incorporated

  dba MACT Optometry, Sonora

  • Clinic/Center
  • Sonora, CA
  • NPI 1033898226

  Member Of

  NPD member

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

All disclosed owners & managing parties 8

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

Owners & managing parties with NPI records 5

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

• M a C T Health Board Incorporated

  dba MACT Medical Jackson

  • Clinic/Center
  • Jackson, CA
  • NPI 1295727287

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• M a C T Health Board Incorporated

  dba MACT Medical Sonora

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1467444364

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Optometry, Sonora

  • Clinic/Center
  • Sonora, CA
  • NPI 1033898226

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Medical San Andreas

  • Clinic/Center
  • San Andreas, CA
  • NPI 1346410255

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Medical Mariposa

  • Clinic/Center
  • Mariposa, CA
  • NPI 1740272731

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

All facility ownership & control disclosures 4

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

Owned or controlled facilities with NPI records 11

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

• M a C T Health Board Incorporated

  dba MACT Behavioral Health, Sonora

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1154147445

  5% Or Greater Direct Ownership Interest

  CMS ownership
• M a C T Health Board Incorporated

  dba MACT Medical Jackson

  • Clinic/Center
  • Jackson, CA
  • NPI 1295727287

  Operational/Managerial Control

  CMS ownership
• M a C T Health Board Incorporated

  dba MACT Medical Sonora

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1467444364

  Operational/Managerial Control

  CMS ownership
• M a C T Health Board Incorporated

  dba MACT Behavioral Health, Valley Springs

  • Federally Qualified Health Center (FQHC)
  • Valley Springs, CA
  • NPI 1649091109

  5% Or Greater Direct Ownership Interest

  CMS ownership
• M a C T Health Board Incorporated

  dba MACT Sonora Women's Health Center

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1871233692

  5% Or Greater Direct Ownership Interest

  CMS ownership
• M a C T Health Board Incorporated

  dba MACT Sonora Pediatric Health Center

  • Clinic/Center
  • Sonora, CA
  • NPI 1871237040

  5% Or Greater Direct Ownership Interest

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Optometry, Sonora

  • Clinic/Center
  • Sonora, CA
  • NPI 1033898226

  5% Or Greater Direct Ownership Interest

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Medical San Andreas

  • Clinic/Center
  • San Andreas, CA
  • NPI 1346410255

  Operational/Managerial Control

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Health & Wellness, Sutter Creek

  • Federally Qualified Health Center (FQHC)
  • Sutter Creek, CA
  • NPI 1417741869

  5% Or Greater Direct Ownership Interest

  CMS ownership
• M a C T Health Board, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Bear Valley, CA
  • NPI 1508724337

  5% Or Greater Direct Ownership Interest

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Medical Mariposa

  • Clinic/Center
  • Mariposa, CA
  • NPI 1740272731

  5% Or Greater Direct Ownership Interest

  CMS ownership

Facilities with the same owner 4

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

• M a C T Health Board Incorporated

  dba MACT Medical Jackson

  • Clinic/Center
  • Jackson, CA
  • NPI 1295727287

  M a C T Health Board Incorporated

  CMS ownership
• M a C T Health Board Incorporated

  dba MACT Medical Sonora

  • Federally Qualified Health Center (FQHC)
  • Sonora, CA
  • NPI 1467444364

  M a C T Health Board Incorporated

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Medical San Andreas

  • Clinic/Center
  • San Andreas, CA
  • NPI 1346410255

  M a C T Health Board Incorporated

  CMS ownership
• M a C T Health Board, Incorporated

  dba MACT Medical Mariposa

  • Clinic/Center
  • Mariposa, CA
  • NPI 1740272731

  M a C T Health Board Incorporated

  CMS ownership

Practitioners 67

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.

• Daniel Ross Cockrell, D.C.

  • Chiropractor
  • Sutter Creek, CA
  • NPI 1275863938

  TX

  Medicare reassignment Care Compare group NPD
• Jeffrey Reichert, D.C., B.S.

  • Chiropractor
  • Castro Valley, CA
  • NPI 1659644375

  TX

  Medicare reassignment Care Compare group NPD
• John Knox Maltby II, D.C.

  • Chiropractor
  • Eagle, ID
  • NPI 1164805750

  TX

  Medicare reassignment Care Compare group NPD
• Estevan Acuna, FNP

  • Family Nurse Practitioner
  • Sonora, CA
  • NPI 1104821032

  TX

  Medicare reassignment Care Compare group
• Kirmanj Tahsin Atrushi, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Jackson, CA
  • NPI 1871026179

  TX

  Medicare reassignment Care Compare group
• Charles Lindsay Edwards, M.D.

  • Psychiatry Physician
  • Sonora, CA
  • NPI 1063505972

  TX

  Medicare reassignment Care Compare group
• Livia Speare Galli Rasmussen, OD, MS

  • Optometrist
  • Sonora, CA
  • NPI 1417618117

  TX

  Medicare reassignment Care Compare group
• Sunni Erika Gessel, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Sonora, CA
  • NPI 1184388332

  TX

  Medicare reassignment Care Compare group
• Christy Hobgood

  • Clinical Social Worker
  • Jackson, CA
  • NPI 1316482136

  TX

  Medicare reassignment Care Compare group
• Walter Kip Johnson, M.D.

  • General Practice Physician
  • Ione, CA
  • NPI 1780919282

  TX

  Medicare reassignment Care Compare group
• Christopher Lee Jones, M.D.

  • Obstetrics & Gynecology Physician
  • Sonora, CA
  • NPI 1649594417

  TX

  Medicare reassignment Care Compare group
• Ravinder R. Kadevari, M.D.

  • Family Medicine Physician
  • Mariposa, CA
  • NPI 1306873922

  TX

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1785283200000",
    "number": "1366519431",
    "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": "209-736-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113 HIGHWAY 49",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "95249",
            "telephone_number": "209-755-1400",
            "fax_number": "209-755-1430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1906 Vista Del Lago Dr Ste L",
            "address_purpose": "LOCATION",
            "city": "Valley Springs",
            "state": "CA",
            "postal_code": "952529700",
            "country_code": "US",
            "telephone_number": "209-755-1490",
            "fax_number": "209-459-4074",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "940 Sylva Ln Ste B",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953705969",
            "country_code": "US",
            "telephone_number": "209-288-6530",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "940 Sylva Ln Ste F1",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953705969",
            "country_code": "US",
            "telephone_number": "209-674-6197",
            "fax_number": "209-674-6203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "75 Diamond Valley Rd Unit B",
            "address_purpose": "LOCATION",
            "city": "Markleeville",
            "state": "CA",
            "postal_code": "961209579",
            "country_code": "US",
            "telephone_number": "530-694-2146",
            "fax_number": "530-694-2770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1906 Vista Del Lago Dr Ste K",
            "address_purpose": "LOCATION",
            "city": "Valley Springs",
            "state": "CA",
            "postal_code": "952529700",
            "country_code": "US",
            "telephone_number": "209-755-1490",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13975 Mono Way Ste J",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953702824",
            "country_code": "US",
            "telephone_number": "209-588-4640",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "52 S Main St Ste B",
            "address_purpose": "LOCATION",
            "city": "Angels Camp",
            "state": "CA",
            "postal_code": "952229153",
            "country_code": "US",
            "telephone_number": "209-674-6181",
            "fax_number": "209-674-6191",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "940 Sylva Ln Ste A",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953705969",
            "country_code": "US",
            "telephone_number": "209-288-6502",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "940 Sylva Ln Ste H",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953705969",
            "country_code": "US",
            "telephone_number": "209-532-4123",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "905 Morning Star Dr",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953709249",
            "country_code": "US",
            "telephone_number": "209-533-9600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13975 Mono Way Ste G",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953702824",
            "country_code": "US",
            "telephone_number": "209-533-9600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12140 New York Ranch Rd",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "CA",
            "postal_code": "956429407",
            "country_code": "US",
            "telephone_number": "209-257-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "321 State Highway 49",
            "address_purpose": "LOCATION",
            "city": "Sutter Creek",
            "state": "CA",
            "postal_code": "956854211",
            "country_code": "US",
            "telephone_number": "209-257-2480",
            "fax_number": "209-674-3909",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "367 Creekside Dr",
            "address_purpose": "LOCATION",
            "city": "Bear Valley",
            "state": "CA",
            "postal_code": "952239455",
            "country_code": "US",
            "telephone_number": "209-562-0899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1113A Highway 49",
            "address_purpose": "LOCATION",
            "city": "San Andreas",
            "state": "CA",
            "postal_code": "952499583",
            "country_code": "US",
            "telephone_number": "209-755-1480",
            "fax_number": "209-674-6190",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19177 State Highway 120",
            "address_purpose": "LOCATION",
            "city": "Groveland",
            "state": "CA",
            "postal_code": "953219701",
            "country_code": "US",
            "telephone_number": "209-754-6262",
            "fax_number": "209-736-1814",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "305 Preston Ave",
            "address_purpose": "LOCATION",
            "city": "Ione",
            "state": "CA",
            "postal_code": "956409158",
            "country_code": "US",
            "telephone_number": "209-674-6182",
            "fax_number": "209-398-8759",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "940 Sylva Ln Ste D1",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953705969",
            "country_code": "US",
            "telephone_number": "209-588-4680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12150 New York Ranch Rd",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "CA",
            "postal_code": "956429407",
            "country_code": "US",
            "telephone_number": "209-257-2460",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5192 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "Mariposa",
            "state": "CA",
            "postal_code": "953389524",
            "country_code": "US",
            "telephone_number": "209-742-6144",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "52 S Main St",
            "address_purpose": "LOCATION",
            "city": "Angels Camp",
            "state": "CA",
            "postal_code": "952229153",
            "country_code": "US",
            "telephone_number": "209-754-6262",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13975 Mono Way Ste I",
            "address_purpose": "LOCATION",
            "city": "Sonora",
            "state": "CA",
            "postal_code": "953702824",
            "country_code": "US",
            "telephone_number": "209-533-9603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5204 Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "Mariposa",
            "state": "CA",
            "postal_code": "953389524",
            "country_code": "US",
            "telephone_number": "209-966-0573",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "M A C T HEALTH BOARD INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2026-07-29",
        "certification_date": "2026-07-29",
        "status": "A",
        "authorized_official_last_name": "CONTRERAS",
        "authorized_official_first_name": "MARIELA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-754-6262",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "550000678",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Rae Liberty, LCSW
• Jesse Steven Limas, MFT
• Shannon M Linton, MD, PHD
• Cynthia Ann Lopez
• Rebecca Rochelle Lopez
• M a C T Health Board, Incorporated (MACT Medical San Andreas)
• M a C T Health Board, Incorporated
• Heather Nicole Mack
• Pilar Majors, LCSW
• Mark Twain Medical Center (Family Medical Center - San Andreas)

• Federally Qualified Health Center (FQHC) in San Andreas, CA
• Providers in San Andreas, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2026; 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.

Verify at the official NPI Registry.