NPIMap

Centro de Salud de la Comunidad de San Ysidro Inc

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

NPI 1457033813 · NPPES record last updated Oct 6, 2023

Key facts

NPI
1457033813
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO INC
Practice address
1525 Fourth Ave, 2ND Floor
San Diego, CA 92101-3107
Phone
(619) 662-4100
NPI assigned
Aug 4, 2023
Organization subpart
No

Authorized official

Name
Kevin Mattson
Title
President/Ceo
Phone
(619) 662-4100

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs on the same Medicare enrollment 40

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

View all 40

Corporate family (same tax ID) 24

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

Practitioners 587

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

View all 587

Medicare participation

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

Federally qualified health center certification: CCN A01860

Legal name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
SAN YSIDRO HEALTH SENIOR DENTAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 10, 2024
Last certification
May 10, 2024
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Feb 5, 1971 in CA
Enrollment address
1525 4TH Ave
FL 2
San Diego, CA 92101-3107

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Tomas Urtasun
Individual 		Corporate Director
Board Member		 Apr 1, 2010
Guillermo Gomez
Individual 		Corporate Director
Board Member		 Oct 20, 2012
Catalina Valencia
Individual 		Corporate Director
Board Member		 Oct 28, 2017
William Wallace
Individual 		Corporate Officer
VP/Cfo		 Jan 20, 2016
Victor Nieto
Individual 		Corporate Director
Board Member		 Jan 27, 1999
Reynaldo Perez
Individual 		Corporate Director
Board Member		 Apr 1, 1994
Michael Dew
Individual 		Corporate Officer
Managed Care Director		 Dec 1, 2021
W-2 Managing Employee
Managed Care Director		 Dec 1, 2021
Fred Dorsey
Individual 		Corporate Director
Board Member		 Oct 20, 2016
Kusay I Arabo
Individual 		Corporate Director
Board Member		 Aug 24, 2017
Gloria Ramirez
Individual 		Corporate Director
Board Member		 Aug 4, 1994
Macario Gutierrez
Individual 		Corporate Director
Board Member		 May 20, 1975
Kevin Mattson
Individual 		Corporate Officer
President/Ceo		 Jul 1, 2002
Margarita Navarro
Individual 		Corporate Director
Board Member		 Apr 30, 1997

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
San Ysidro Health CHC-Ocean View
San Diego, CA · CCN 551920		 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2008
San Ysidro Health Euclid
San Diego, CA · CCN 551922		 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2009
San Ysidro Health Otay
Chula Vista, CA · CCN 551966		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 5, 1971
San Ysidro Health San Diego Pace/Senior Health Services
San Ysidro, CA · CCN 751102		 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2014
San Ysidro Health El Cajon/San Diego Pace
El Cajon, CA · CCN 751822		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2015
San Ysidro Health South Bay
National City, CA · CCN 751950		 Federally qualified health center 5% Or Greater Direct Ownership Interest (5%) Jun 1, 2016

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040130000711 CA Part B Supplier - Clinic/Group Practice 6901709435 Receives reassigned benefits from 611 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: National City, CA; San Diego, CA; San Ysidro, CA; Santee, CA; Vista, CA; Alpine, CA; Campo, CA; Chula Vista, CA…
O20240514003996 CA Part a Provider - Federally Qualified Health Center (FQHC) 6901709435 Practice locations: San Diego, CA

National Provider Directory

Tax ID family
Centro de Salud de la Comun (51 organizations share this tax ID)

Locations

1620 Alpine Blvd
#107111
Alpine, CA 91901

340 Fourth Ave
Ste 7
Chula Vista, CA 91910
Phone (619) 428-1330

1061 Tierra del Rey
Ste 303305
Chula Vista, CA 91910

436 S Magnolia Ave
#101201
El Cajon, CA 92020
Phone (619) 401-7410

2 N Euclid Ave
Ste C
National City, CA 91950
Phone (619) 205-6363

550 Washington St
Ste 331
San Diego, CA 92103
Phone (619) 297-5437

8110 Birmingham Way
San Diego, CA 92123
Phone (858) 966-4003

3045 Beyer Blvd
Ste D101
San Diego, CA 92154

1525 4th Ave
Fl 2
San Diego, CA 92101
Phone (616) 662-4100

1660 Precision Park Ln
San Ysidro, CA 92173
Phone (619) 994-3743

Specialties & licenses

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

Addresses

Primary practice location

1525 Fourth Ave, 2ND Floor
San Diego, CA 92101-3107

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 662-4100

Other names

  • San Ysidro Health Senior Dental Center Doing business as

Other providers in San Diego, CA

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

Sources for this page

Verify at the official NPI Registry.