NPIMap

Organization Active NPI

County of San Bernardino

Doing business as Phoenix Community Counseling

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Bernardino, CA
National Provider Identifier
1417168246
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
ZZZ74743Z Issued in CA
Legal business name
COUNTY OF SAN BERNARDINO
Doing business as
Phoenix Community Counseling
Practice address
820 E Gilbert St
San Bernardino, CA 92415-0928
Phone
(909) 387-7200
NPI assigned
May 24, 2007
Last updated
Sep 7, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
DEPARTMENT OF BEHAVIORAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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

Authorized official

Name
Erica Ochoa
Title
Chief Compliance Officer
Phone
(909) 388-0882

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X ZZZ74743Z CA Primary

Addresses

Primary practice location

820 E Gilbert St
San Bernardino, CA 92415-0928

Mailing address

303 E Vanderbilt Way
San Bernardino, CA 92415-0026
Phone (909) 388-0801

Other identifiers 1

IdentifierTypeStateIssuer
3600036B3OtherCAMEDICAL PROVIDER NUMBER

Other names 1

  • Phoenix Community Counseling Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209000420 CA Part B Supplier - Clinic/Group Practice 3870499130 Receives reassigned benefits from 233 practitioners
35 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Needles, CA; Victorville, CA; San Bernardino, CA; Rialto, CA; Ontario, CA; Hesperia, CA; Fontana, CA; Colton, CA…

Other NPIs on the same Medicare enrollment 31

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

View all 31

National Provider Directory

National Provider Directory
Tax ID family
San Bernardino County D143 organizations share this tax ID, including this one
Part of
San Bernardino County D

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

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662508800000",
    "number": "1417168246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E VANDERBILT WAY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150026",
            "telephone_number": "909-388-0801",
            "fax_number": "909-890-0435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E GILBERT ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150928",
            "telephone_number": "909-387-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SAN BERNARDINO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DEPARTMENT OF BEHAVIORAL HEALTH",
        "enumeration_date": "2007-05-24",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A",
        "authorized_official_last_name": "OCHOA",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "909-388-0882"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "ZZZ74743Z",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL PROVIDER NUMBER",
            "identifier": "3600036B3",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Community Counseling",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Phoenix Community Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.