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Community Health Centers of the Central Coast Inc

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

NPI 1376560151 · NPPES record last updated Jan 21, 2019

Key facts

NPI
1376560151
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Practice address
4723 W Main St Ste H
Guadalupe, CA 93434-1787
Phone
(805) 343-5577
Fax
(805) 343-5578
NPI assigned
Jul 16, 2006
Organization subpart
No

Authorized official

Name
Ronald E Castle
Title
Chief Executive Officer
Phone
(805) 346-3905

Other NPIs on the same Medicare enrollment 27

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

View all 27

Other NPIs with the same Medicare PAC ID 22

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

Practitioners 78

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 78

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

Federally qualified health center certification: CCN 551973

Legal name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Doing business as
COMMUNITY HEALTH CENTERS GUADALUPE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 15, 2004
Last certification
Jun 15, 2004
Ownership / control type
For profit – corporation
Organization structure
Other · Non-profit
Incorporated
May 8, 1978 in CA
Enrollment address
4723 W Main St
Ste H
Guadalupe, CA 93434-1787

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Sam Orozco
Individual 		Corporate Officer
Board Member Treasurer		 Nov 1, 2017 5%
Linda L Costa
Individual 		Corporate Officer
Chief Financial Officer		 Nov 1, 2017 5%
Ronald E Castle
Individual 		Corporate Officer
Chief Executive Officer		 May 1, 1980 15%
Barbara a Allen
Individual 		W-2 Managing Employee
Business Office Manager		 Jan 1, 2011 5%
William Gordon
Individual 		Corporate Director
Board of Directors		 Jan 1, 2011 5%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040115001161 CA Part B Supplier - Clinic/Group Practice 7416868120 Receives reassigned benefits from 236 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Maria, CA; Paso Robles, CA; San Luis Obispo, CA; Templeton, CA; Oceano, CA; Arroyo Grande, CA; Atascadero, CA; Cambria, CA…
O20040512001225 CA Part a Provider - Federally Qualified Health Center (FQHC) 7416868120 Practice locations: Guadalupe, CA

National Provider Directory

Specialties & licenses

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

Addresses

Primary practice location

4723 W Main St Ste H
Guadalupe, CA 93434-1787

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8028

Other names

  • Community Health Centers Guadalupe Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 21, 2019.

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548028800000",
    "number": "1376560151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8028",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4723 W MAIN ST STE H",
            "city": "GUADALUPE",
            "state": "CA",
            "postal_code": "934341787",
            "telephone_number": "805-343-5577",
            "fax_number": "805-343-5578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2019-01-21",
        "status": "A",
        "authorized_official_last_name": "CASTLE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "805-346-3905"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Centers Guadalupe",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Community Health Centers Guadalupe",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Guadalupe, CA

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

Sources for this page

Verify at the official NPI Registry.