NPIMap

Organization Active NPI

Santa Cruz Community Health Centers

Doing business as Santa Cruz Mountain Health Center 2

  • Clinic/Center
  • Ben Lomond, CA
National Provider Identifier
1386329142
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
SANTA CRUZ COMMUNITY HEALTH CENTERS
Doing business as
Santa Cruz Mountain Health Center 2
Practice address
231 Main St Ste a
Ben Lomond, CA 95005-9394
Phone
(831) 427-3500
Fax
(831) 426-3286
NPI assigned
Jun 20, 2023
Last updated
Jun 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SANTA CRUZ COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Authorized official

Name
Ruth Jasso
Title
Revenue Cycle Director
Phone
(831) 427-3500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

231 Main St Ste a
Ben Lomond, CA 95005-9394

Mailing address

PO Box 542
Santa Cruz, CA 95061-0542
Phone (831) 427-3500

Other names 1

  • Santa Cruz Mountain Health Center 2 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041004000763 CA Part B Supplier - Clinic/Group Practice 0840259107 Receives reassigned benefits from 31 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ben Lomond, CA; Santa Cruz, CA
O20230929000873 CA Part A Provider - Federally Qualified Health Center (FQHC) 0840259107 Practice locations: Ben Lomond, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386329142. Details of each certification follow.

Federally qualified health center certification: CCN A01197

Legal name
SANTA CRUZ COMMUNITY HEALTH CENTERS
Doing business as
SANTA CRUZ MOUNTAIN HEALTH CENTER 2
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 20, 2023
Last certification
Sep 20, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 14, 1975 in CA
Enrollment address
231 Main St
Ste a
Ben Lomond, CA 95005-9394

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2342522Santa Cruz Mountain Health Center 2231 Main Street, Suite a, Ben Lomond, CA 95005Provider-performed microscopyApr 20, 2028

National Provider Directory

National Provider Directory
Part of
Santa Cruz Community Health Centers

Locations

21507 E Cliff Dr
Santa Cruz, CA 95062
Phone (510) 520-7299

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Santa Cruz Community Health Centers Organization, Santa Cruz, CA Corporation, Non-profit Operational/Managerial Control Jan 1, 2023
William Leland Individual Corporate DirectorBoard of Director Jan 1, 2014
Joyce Brown Individual Corporate DirectorBoard of Director Jan 1, 2023
Glenys Davidson Individual Corporate DirectorBoard of Director Jan 1, 2023
Andrew Goldenkranz Individual Corporate DirectorBoard of Director Jan 1, 2023
Bianca Crowbear Individual Corporate DirectorBoard of Director Jan 1, 2023
Anita Aguirre Individual Corporate OfficerCeo Jan 8, 2024 100%
W-2 Managing EmployeeCeo Jan 8, 2024 100%
Colleen McLaughlin Individual Corporate DirectorBoard of Director Jan 1, 2023
Jorge Savala Individual Corporate DirectorBoard of Director Jan 1, 2022
Randolph Pozos Individual Corporate DirectorBoard of Director Jan 1, 2023

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Santa Cruz Community Health CentersSanta Cruz, CA, CCN 551081 Federally qualified health center Other Jan 1, 2022
Santa Cruz Community Health CentersSanta Cruz, CA, CCN 751052 Federally qualified health center Other Jan 1, 2022

Owned or controlled facilities with NPI records 2

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1386329142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 542",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950610542",
            "telephone_number": "831-427-3500",
            "fax_number": "831-426-3286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 MAIN ST STE A",
            "city": "BEN LOMOND",
            "state": "CA",
            "postal_code": "950059394",
            "telephone_number": "831-427-3500",
            "fax_number": "831-426-3286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA CRUZ COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANTA CRUZ COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "JASSO",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "831-427-3500"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Santa Cruz Mountain Health Center 2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ben Lomond, CA

Sources for this page

Verify at the official NPI Registry.