NPIMap

Organization Active NPI

Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Guadalupe, CA
National Provider Identifier
1376560151
Registry record updated Jan 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jan 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2019

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • Community Health Centers Guadalupe Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1376560151. Details of each certification follow.

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
OtherNon-profit
Incorporated
May 8, 1978 in CA
Enrollment address
4723 W Main St
Ste H
Guadalupe, CA 93434-1787

Federally qualified health center certification: CCN 051932

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MARIAN COMMUNITY CLINICS GUADALUPE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 1, 1994
Last certification
Jun 1, 1994
Ownership / control type
For profit – partnership
Facility address
4723 W Main St Ste H
Guadalupe, CA 93434

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory

Ownership & related parties

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 OfficerBoard Member Treasurer Nov 1, 2017 5%
Linda L Costa Individual Corporate OfficerChief Financial Officer Nov 1, 2017 5%
Ronald E Castle Individual Corporate OfficerChief Executive Officer May 1, 1980 15%
Barbara a Allen Individual W-2 Managing EmployeeBusiness Office Manager Jan 1, 2011 5%
William Gordon Individual Corporate DirectorBoard of Directors Jan 1, 2011 5%

Practitioners & affiliated clinicians

Practitioners 7

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": "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

Sources for this page

Verify at the official NPI Registry.