NPIMap

Organization Active NPI

Riverside-San Bernardino County Indian Health, Inc

Doing business as Morongo Indian Health

  • Federally Qualified Health Center (FQHC)
  • Banning, CA
National Provider Identifier
1437202124
Registry record updated Aug 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC
Doing business as
Morongo Indian Health
Practice address
11555 1/2 Potrero Rd
Banning, CA 92220-6946
Phone
(951) 849-4761
Fax
(951) 849-5612
NPI assigned
Jan 18, 2007
Last updated
Aug 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2021

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • Morongo Indian Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437202124. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Apr 3, 1974 in CA
Enrollment address
11555 1/2 Potrero Rd
Banning, CA 92220-6946

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 9

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
05D0060932Morongo Indian Health Center11555 1/2 Potrero Road, Banning, CA 92220Certificate of waiverFeb 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Rsbcihi20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Member of 1

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

Locations

53000 Cahuilla Rd
Anza, CA 92539
Phone (909) 864-1097

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

Ownership & related parties

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 DirectorChief 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 EmployeeContracting / 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

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.

    dba San Manuel Indian Health

    • Federally Qualified Health Center (FQHC)
    • Grand Terrace, CA
    • NPI 1174676670

    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

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1437202124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11980 MOUNT VERNON AVE",
            "city": "GRAND TERRACE",
            "state": "CA",
            "postal_code": "923135172",
            "telephone_number": "909-864-1097",
            "fax_number": "909-744-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11555 1/2 POTRERO RD",
            "city": "BANNING",
            "state": "CA",
            "postal_code": "922206946",
            "telephone_number": "951-849-4761",
            "fax_number": "951-849-5612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "THOMSEN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-864-1097"
    },
    "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": "Morongo Indian Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Morongo Indian Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Banning, CA

Sources for this page

Verify at the official NPI Registry.