NPIMap

Riverside-San Bernardino County Indian Health, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Banning, CA

NPI 1437202124 · NPPES record last updated Aug 25, 2021

Key facts

NPI
1437202124
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC
Practice address
11555 1/2 Potrero Rd
Banning, CA 92220-6946
Phone
(951) 849-4761
Fax
(951) 849-5612
NPI assigned
Jan 18, 2007
Organization subpart
No

Authorized official

Name
William Thomsen
Title
Ceo
Phone
(909) 864-1097

Other NPIs on the same Medicare enrollment 9

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

Other NPIs with the same Medicare PAC ID 6

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

Corporate family (same tax ID) 19

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Riverside-San Bernardino County Indian Health, Inc. Federally Qualified Health Center (FQHC) · Grand Terrace, CA · NPI 1174676670
    CMS ownership AGUA CALIENTE BAND OF CAHUILLA INDIANS · CAHUILLA BAND OF INDIANS · MORONGO BAND OF MISSION INDIANS · PECHANGA BAND OF TEMECULA INDIANS · RAMONA BAND OF CAHUILLA · SAN MANUEL BAND OF MISSION INDIANS · SANTA ROSA BAND OF CAHUILLA INDIANS · SOBOBA BAND OF L

Practitioners 58

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 58

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0060932Morongo Indian Health Center
11555 1/2 Potrero Road, Banning, CA 92220		Certificate of waiverFeb 28, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA, TX

Federally qualified health center certification: CCN 051909

Legal name
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH INC
Doing business as
MORONGO INDIAN HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1994
Last certification
Jan 1, 1994
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Apr 3, 1974 in CA
Enrollment address
11555 1/2 Potrero Rd
Banning, CA 92220-6946

All disclosed owners & managing parties 29

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

NameRoleSinceShare
Agua Caliente Band of Cahuilla Indians
Organization · Palm Springs, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Cahuilla Band of Indians
Organization · Anza, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Fort Mojave Indian Tribe
Organization · Needles, CA 		5% Or Greater Direct Ownership Interest Mar 8, 2011
Pechanga Band of Temecula Indians
Organization · Temecula, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Veronica E Saul
Individual 		Corporate Director Mar 8, 2011
Sandra Marquez
Individual 		Corporate Director Dec 8, 2010
Soboba Band of Luiseno Indians
Organization · San Jacinto, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Isadora M Evanston
Individual 		Corporate Director Dec 8, 2010
Jackie Wisespirit
Individual 		Corporate Director Mar 8, 2011
William Thomsen
Individual 		Corporate Director
Chief Executive Officer		 May 1, 2021 100%
Ramona Band of Cahuilla
Organization · Anza, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Mary James
Individual 		Corporate Director Mar 8, 2011
Torres-Martinez Desert Cahuilla Indians
Organization · Thermal, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Morongo Band of Mission Indians
Organization · Banning, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Randalyn Vasquez
Individual 		Corporate Director Dec 8, 2010
Vuliet Danial
Individual 		W-2 Managing Employee
Contracting / Credentialing		 Nov 16, 2018
John M Marcus
Individual 		Corporate Director Mar 8, 2011
Desiree Franco
Individual 		Corporate Director Dec 8, 2010
Sherri Salgado
Individual 		Corporate Director Mar 8, 2011
Faith M Morreo
Individual 		Corporate Director Mar 8, 2011
Teresa L Sanchez
Individual 		Corporate Director Dec 8, 2010
Jonell John
Individual 		Corporate Director Dec 8, 2010
Veronica Uhrle
Individual 		Corporate Director Dec 8, 2010
Santa Rosa Band of Cahuilla Indians
Organization · Anza, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Michele M Cornejo
Individual 		Corporate Director Dec 8, 2010
San Manuel Band of Mission Indians
Organization · Highland, CA 		5% Or Greater Direct Ownership Interest Apr 3, 1974 11.11%
Suzanne Lugo
Individual 		Corporate Director Mar 8, 2011
Charles Castello
Individual 		Corporate Director Mar 8, 2011
Anita Soza
Individual 		Corporate Director Mar 8, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20110329000210 CA Part a Provider - Federally Qualified Health Center (FQHC) 4789867805 Practice locations: Banning, CA
O20150508001121 TX Part B Supplier - Clinic/Group Practice 4789867805 Receives reassigned benefits from 98 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thermal, CA; Temecula, CA; San Jacinto, CA; Grand Terrace, CA; Mountain Center, CA; Anza, CA; Barstow, CA; Banning, CA

National Provider Directory

Tax ID family
Riverside San Bernandin (20 organizations share this tax ID)

Locations

170 Yucca Ave
Barstow, CA 92311
Phone (760) 256-9016

23119 Soboba Rd
San Jacinto, CA 92583
Phone (951) 654-0803

Specialties & licenses

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

Addresses

Primary practice location

11555 1/2 Potrero Rd
Banning, CA 92220-6946

Mailing address

11980 Mount Vernon Ave
Grand Terrace, CA 92313-5172
Phone (909) 864-1097

Other identifiers

IdentifierTypeStateIssuer
FHC03854FMedicaidCA

Other names

  • Morongo Indian Health Doing business as

Other providers in Banning, CA

All providers in Banning, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.