Community Health Centers of the Central Coast Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Santa Maria, CA
NPI 1447277355 · NPPES record last updated Jan 21, 2019
Key facts
- NPI
- 1447277355
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
- Practice address
- 2801 Santa Maria Way
BLDG a & B
Santa Maria, CA 93455-2118 - Phone
- (805) 934-5400
- Fax
- (805) 938-9207
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Ronald E Castle
- Title
- Chief Executive Officer
- Phone
- (805) 929-3211
Other NPIs on the same Medicare enrollment 27
Other NPIs with the same Medicare PAC ID 22
Practitioners 243
-
Noor Al-Saud, MD
-
Emilia Ambrosio, MD
-
Susan Bartolini, M.D.
-
Bethany Blacketer, M.D.
-
Shawn C Borges, D.C.
-
Sarah Elizabeth Campbell, LCSW
-
Franco Jason Castrejon, OPTOMETRIST
-
Eric Chau, D.O.
-
Steve Russell Clarke, M.D.
-
Helen George Cominos, C.N.M.
-
Ben Cooke, MD
-
George M Cury, MD
-
James Michael Davis, D.C.
-
Sam Densen, MD
-
Alicia Dueck, LCSW
-
Shahrouz Eman, DC
-
Natalie Eulloqui, LCSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 051872
- Legal name
- COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
- Doing business as
- COMMUNITY HEALTH CENTERS SANTA MARIA
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 8, 1978 in CA
- Enrollment address
- 2801 Santa Maria Way
Santa Maria, CA 93455-2118
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Bertha Campos |
Corporate Director |
May 27, 2004 | 5% |
| Linda L Costa |
Corporate Officer | Jan 1, 2016 | 5% |
| Ronald E Castle |
Corporate Officer |
Apr 1, 1978 | 15% |
| W-2 Managing Employee |
Apr 1, 1978 | 15% | |
| Barbara a Allen |
W-2 Managing Employee |
Jan 1, 2016 | 5% |
| William Gordon |
Corporate Director |
Jun 30, 2011 | 5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040115001161 | CA | Part B Supplier - Clinic/Group Practice | 7416868120 |
Receives reassigned benefits from 236 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Santa Maria, CA; Paso Robles, CA; San Luis Obispo, CA; Templeton, CA; Oceano, CA; Arroyo Grande, CA; Atascadero, CA; Cambria, CA… |
| O20040510001180 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 7416868120 | Practice locations: Santa Maria, CA |
National Provider Directory
Locations
1414 S Miller St
Ste 9
Santa Maria, CA 93454
Phone (805) 934-5400
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
2801 Santa Maria Way
BLDG a & B
Santa Maria, CA 93455-2118
Mailing address
2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8028
Other names
- Community Health Centers Santa Maria
Other providers in Santa Maria, CA
- Community Health Center of the Central Coast Inc
- Community Health Centers of the Central Coast
- Community Health Centers of the Central Coast Inc
- Community Health Centers of the Central Coast Inc
- Community Health Centers of the Central Coast Inc
- Community Health Centers of the Central Coast Inc
- Community Health Centers of the Central Coast Inc
- Community Health Centers of the Central Coast Inc
- Community Health Centers of the Central Coast, Inc
- Community Health Centers of the Central Coast, Inc
All providers in Santa Maria, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.