NPIMap

Organization Active NPI

Wellspace Health

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1437404654
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WELLSPACE HEALTH
Practice address
10423 Old Placerville Rd Ste a
Sacramento, CA 95827-2540
Phone
(916) 569-8600
Fax
(916) 368-0815
NPI assigned
Jul 14, 2012
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Dr. Alasdair Jonathan Porteus, PHD
Title
Chief Executive Officer
Phone
(916) 737-5555

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
ContractorGroup: 193200000X MULTI-SPECIALTY GROUP 171W00000X
Developmentally Disabled Services Day Training Agency 251C00000X
Supports Brokerage Agency 251X00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Home Delivered Meals 332U00000X
Personal Care AttendantGroup: 193200000X MULTI-SPECIALTY GROUP 3747P1801X
Respite Care 385H00000X

Addresses

Primary practice location

10423 Old Placerville Rd Ste a
Sacramento, CA 95827-2540

Mailing address

1820 J St
Sacramento, CA 95811-3010
Phone (916) 550-5481

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070623000117 CA Part B Supplier - Clinic/Group Practice 8426157975 Receives reassigned benefits from 123 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Jackson, CA; Citrus Heights, CA; Folsom, CA; North Highlands, CA; Roseville, CA
O20160728001033 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426157975 Practice locations: Sacramento, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437404654. Details of each certification follow.

Federally qualified health center certification: CCN 751910

Legal name
WELLSPACE HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 11, 2016
Last certification
Jul 11, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 3, 1970 in CA
Enrollment address
10423 Old Placerville Rd
Ste a
Sacramento, CA 95827-2540

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 23

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

View all 23

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
05D2058801Wellspace Health Rancho Cordova10423 Old Placerville Rd Ste a, Sacramento, CA 95827Certificate of waiverJan 7, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Brenda a Shipp Individual Corporate OfficerCoo Jun 9, 2014
W-2 Managing EmployeeCoo Jun 9, 2014
Operational/Managerial ControlCoo Jun 9, 2014
Ruth Pasillas Gonzales Individual Corporate DirectorBoard Secretary Jul 31, 2015
Lawrence Maas Individual Corporate DirectorBoard Director Jul 31, 2015
Lisa Stewart Individual Corporate DirectorBoard Director Jul 31, 2015
James Tilton Individual Corporate DirectorBoard Secretary Jul 31, 2015
Jonathan a Porteus Individual Corporate OfficerCeo Jan 1, 2011
W-2 Managing EmployeeCeo Jan 1, 2011
Operational/Managerial Control Jan 1, 2011
Ruzwa Cooper Individual Corporate DirectorBoard President Jul 31, 2015
Pamela Mullins Individual Corporate DirectorBoard Director Jul 31, 2015
Jo Ann 'Jody' Gray Individual Corporate DirectorBoard Director Jul 31, 2015
Steven Olds Individual Corporate DirectorBoard Treasurer Jul 31, 2015

All facility ownership & control disclosures 11

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

FacilityTypeRoleSince
Wellspace HealthSacramento, CA, CCN 051142 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health North Highlands Community Health CenterNorth Highlands, CA, CCN 551020 Federally qualified health center Operational/Managerial Control Nov 27, 2011
Wellspace HealthSacramento, CA, CCN 551021 Federally qualified health center Operational/Managerial Control Jan 4, 2010
Wellspace HealthSacramento, CA, CCN 551022 Federally qualified health center Operational/Managerial Control May 17, 2010
Wellspace HealthRoseville, CA, CCN 751000 Federally qualified health center Operational/Managerial Control Mar 16, 2012
Wellspace Health Healthcare for Women Community Health CenterSacramento, CA, CCN 921070 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921843 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921842 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921841 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sunrise CommunityCitrus Heights, CA, CCN 921844 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sierra Garden 2Roseville, CA, CCN 921840 Federally qualified health center Operational/Managerial Control Feb 7, 1970

Owned or controlled facilities with NPI records 11

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

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1342224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1437404654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 J ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958113010",
            "telephone_number": "916-550-5481",
            "fax_number": "916-822-8974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10423 OLD PLACERVILLE RD STE A",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272540",
            "telephone_number": "916-569-8600",
            "fax_number": "916-368-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPACE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-14",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "PORTEUS",
        "authorized_official_first_name": "ALASDAIR",
        "authorized_official_middle_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "916-737-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.