NPIMap

Organization Active NPI

Sac Health System

Doing business as SAC Indio CVRM Manila

  • Federally Qualified Health Center (FQHC)
  • Indio, CA
National Provider Identifier
1386299204
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAC HEALTH SYSTEM
Doing business as
SAC Indio CVRM Manila
Practice address
84110 Manila Ave # B
Indio, CA 92201-7128
Phone
(909) 382-7100
NPI assigned
Aug 7, 2019
Last updated
Apr 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Authorized official

Name
Tasha Amick
Title
Director of Billing
Phone
(909) 382-7100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

84110 Manila Ave # B
Indio, CA 92201-7128

Mailing address

250 S G St
San Bernardino, CA 92410-3320
Phone (909) 382-7100

Other identifiers 3

IdentifierTypeStateIssuer
CMM70708FMedicaidCA
EAP70708FOtherCAEAPC
ENVOY3000OtherCAENVOY SITE ID

Other names 1

  • SAC Indio CVRM Manila Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040315000608 CA Part B Supplier - Clinic/Group Practice 4385533579 Receives reassigned benefits from 461 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indio, CA; Murrieta, CA; Rialto, CA; San Bernardino, CA
O20210414002761 CA Part A Provider - Federally Qualified Health Center (FQHC) 4385533579 Practice locations: Indio, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386299204. Details of each certification follow.

Federally qualified health center certification: CCN 921910

Legal name
SAC HEALTH SYSTEM
Doing business as
SAC HEALTH SYSTEM CVRM MANILA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 2021
Last certification
Apr 1, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 18, 1995 in CA
Enrollment address
84110 Manila Ave
# B
Indio, CA 92201-7128

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Sac Health System Norto18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Angela Teresi Individual W-2 Managing Employee Jun 29, 2015
Jason Lohr Individual Corporate OfficerCeo Jun 29, 2018
Eric Ngo Individual Corporate Director Mar 1, 2010
Pat Morris Individual Corporate Director Sep 24, 2019
Raul Castillo Individual Corporate Director Apr 1, 2014
Richard Henry Hart Individual Corporate Director Jul 1, 2014
Edith Ann Atkinson Individual Corporate Director Mar 1, 2010
Rodney Neal Individual Corporate Director Sep 1, 2014
John B Skelton Individual Corporate Officer Apr 8, 2019
Matthew J List Individual Corporate Director Oct 22, 2019
Marilyn Hermann Individual Corporate Director Mar 1, 2010

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745193600000",
    "number": "1386299204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 S G ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924103320",
            "telephone_number": "909-382-7100",
            "fax_number": "909-382-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "84110 MANILA AVE # B",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922017128",
            "telephone_number": "909-382-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAC HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-07",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A",
        "authorized_official_last_name": "AMICK",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "909-382-7100"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70708F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP70708F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ENVOY SITE ID",
            "identifier": "ENVOY3000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAC Indio CVRM Manila",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAC Indio CVRM Manila",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indio, CA

Sources for this page

Verify at the official NPI Registry.