NPIMap

Organization Active NPI

Indian Health Center of Santa Clara Valley

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Jose, CA
National Provider Identifier
1366726903
Registry record updated Nov 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
070000482 Issued in CA
Legal business name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Practice address
602 E Santa Clara St
San Jose, CA 95112-1908
Phone
(408) 445-3400
Fax
(408) 448-1727
NPI assigned
Sep 30, 2011
Last updated
Nov 7, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
INDIAN HEALTH CENTER OF SANTA CLARA VALLEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2024

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

Authorized official

Name
Dr. Aldon Wayne Scott, D.M.
Title
Director of Operations
Phone
(408) 445-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 070000482 CA Primary

Addresses

Primary practice location

602 E Santa Clara St
San Jose, CA 95112-1908

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
FHC11833FOtherCAMEDICAL
55-1120OtherCAMEDICARE PALMETTO

Other names 1

  • Indian Health Center of Santa Clara 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
Tax ID family
Indian Health Ctr SC14 organizations share this tax ID, including this one
Part of
Indian Health Ctr SC

Other organizations with this tax ID 13

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

View all 13

Locations

602 E Santa Clara St
San Jose, CA 95112
Phone 4084453400 ext. 333

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730937600000",
    "number": "1366726903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MERIDIAN AVENUE",
            "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": "602 E SANTA CLARA ST",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951121908",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "enumeration_date": "2011-09-30",
        "last_updated": "2024-11-07",
        "certification_date": "2024-11-07",
        "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": "Dr.",
        "authorized_official_credential": "D.M."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "070000482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "FHC11833F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PALMETTO",
            "identifier": "55-1120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Health Center of Santa Clara",
            "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 Nov 7, 2024; 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.