NPIMap

Organization Active NPI

Community Medical Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Stockton, CA
National Provider Identifier
1407460751
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY MEDICAL CENTERS INC
Practice address
5151 Pacific Ave
Lock Center Room 126 & 128
Stockton, CA 95207-6304
Phone
(209) 940-5660
NPI assigned
Sep 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Authorized official

Name
Mrs. Christine C Noguera
Title
Ceo
Phone
(209) 373-2831

Specialties & licenses 1

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

Addresses

Primary practice location

5151 Pacific Ave
Lock Center Room 126 & 128
Stockton, CA 95207-6304

Mailing address

7210 Murray Dr
Stockton, CA 95210-3339
Phone (209) 373-2800

Other names 1

  • Delta College Health Centers operated By Community Medical Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210827002443 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426968520 Practice locations: Stockton, CA

Federally qualified health center certification: CCN A01016

Legal name
COMMUNITY MEDICAL CENTERS, INC.
Doing business as
COMMUNITY MEDICAL CENTERS, DELTA COLLEGE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 27, 2021
Last certification
Aug 27, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 19, 1978 in CA
Enrollment address
5151 Pacific Ave
RM 126
Stockton, CA 95207-6304

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
CMC Inc Dixon Family PR65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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
Ruby V King Individual Corporate DirectorBoard Member Jul 1, 2018
Jaime DG Allen Individual Corporate OfficerCfo Jan 1, 2019
Lily Aman Individual Corporate DirectorBoard Member Jul 1, 1989
Robert Smith Individual Corporate DirectorBoard Member Jul 1, 2013
Pamela Maffei Individual Corporate DirectorBoard Member Jul 1, 2012
Dora Vivero Individual W-2 Managing EmployeeDirector of Revenue Cycle Aug 19, 1996
Christine C Noguera Individual Corporate OfficerCeo Jul 1, 2014
Jasmine Leek Individual Corporate DirectorBoard Member Jul 1, 2015
Martha Robles Individual Corporate DirectorBoard Member Jan 1, 2019
Peter W Ragsdale Individual Corporate DirectorBoard Member Jul 1, 2018
Martha Dukes Individual Corporate DirectorBoard Member Jul 1, 1985

NPI Registry JSON

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1407460751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210 MURRAY DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103339",
            "telephone_number": "209-373-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5151 PACIFIC AVE",
            "address_2": "LOCK CENTER ROOM 126 & 128",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076304",
            "telephone_number": "209-940-5660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-03",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "NOGUERA",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-373-2831",
        "authorized_official_name_prefix": "Mrs."
    },
    "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": "Delta College Health Centers operated By Community Medical Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.