NPIMap

Organization Active NPI

Santa Rosa Community Health Centers

Doing business as Lombardi Campus

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
National Provider Identifier
1386712065
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
110000300 Issued in CA
Legal business name
SANTA ROSA COMMUNITY HEALTH CENTERS
Doing business as
Lombardi Campus
Practice address
751 Lombardi Court
Santa Rosa, CA 95407-6798
Phone
(707) 547-2222
Fax
(707) 527-0472
NPI assigned
Dec 1, 2006
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Authorized official

Name
Gabriela Bernal-Leroi, CEO
Title
Chief Executive Officer
Phone
(707) 303-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 110000300 CA Primary

Addresses

Primary practice location

751 Lombardi Court
Santa Rosa, CA 95407-6798

Mailing address

3569 Round Barn Circle
Santa Rosa, CA 95403-5781
Phone (707) 303-3600

Other identifiers 1

IdentifierTypeStateIssuer
FHC70663FMedicaidCA

Other names 2

  • Lombardi Campus Doing business as
  • Southwest Community Health Center Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040319001444 CA Part B Supplier - Clinic/Group Practice 0345130423 Receives reassigned benefits from 204 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Rosa, CA
O20070410000292 CA Part A Provider - Federally Qualified Health Center (FQHC) 0345130423 Practice locations: Santa Rosa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386712065. Details of each certification follow.

Federally qualified health center certification: CCN 551848

Legal name
SANTA ROSA COMMUNITY HEALTH CENTERS
Doing business as
SOUTHWEST COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 6, 1998
Last certification
Apr 6, 1998
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 31, 1994 in CA
Enrollment address
751 Lombardi CT
Ste B
Santa Rosa, CA 95407-5454

Other NPIs with the same Medicare PAC ID 4

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

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

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
Gabriela Bernal Leroi Individual Corporate OfficerCeo Jul 1, 2022
W-2 Managing Employee Jul 1, 2022
Operational/Managerial ControlCeo Jul 1, 2022
Karla Garcia Lugo Individual Corporate Director Jul 1, 2013 9%
Cheryl Hergert Individual Corporate OfficerVice Chair Treasurer Jan 1, 2026
Elisa Landauro Johnston Individual Corporate OfficerChair Secretary Jan 1, 2026
Maria de Jesus Dalia Villagomez Pulido Individual Corporate OfficerBoard Member Aug 1, 2015

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Dutton CampusSanta Rosa, CA, CCN 921053 Federally qualified health center Operational/Managerial Control (100%) Apr 2, 2018

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1386712065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3569 ROUND BARN CIRCLE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954035781",
            "telephone_number": "707-303-3600",
            "fax_number": "707-303-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 LOMBARDI COURT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954076798",
            "telephone_number": "707-547-2222",
            "fax_number": "707-527-0472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "BERNAL-LEROI",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-303-3600",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "110000300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70663F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lombardi Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Southwest Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.