NPIMap

Organization Active NPI

St. Jude Neighborhood Health Centers

  • Community Health Clinic/Center
  • Fullerton, CA
National Provider Identifier
1457742447
Registry record updated Jun 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
550000408 Issued in CA
Legal business name
ST. JUDE NEIGHBORHOOD HEALTH CENTERS
Practice address
3232 Topaz LN
Fullerton, CA 92831-2609
Phone
(714) 446-5230
Fax
(714) 449-0726
NPI assigned
Feb 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2020

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

Authorized official

Name
Timothy Jason Brown
Title
Chief Executive Officer
Phone
(208) 899-9631

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 550000408 CA Primary

Addresses

Primary practice location

3232 Topaz LN
Fullerton, CA 92831-2609

Mailing address

731 S Highland Ave
Fullerton, CA 92832-2753
Phone (714) 446-5230

Other names 1

  • Topaz Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150309000080 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284886789 Practice locations: Fullerton, CA

Federally qualified health center certification: CCN 751143

Legal name
ST. JUDE NEIGHBORHOOD HEALTH CENTERS
Organization structure
CorporationNon-profit
Incorporated
Oct 25, 2011 in CA
Enrollment address
3232 Topaz LN
Fullerton, CA 92831-2609

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory
Tax ID family
St Jude Neighborhood Health Centers8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Herlinda E Ramirez Machado Individual Corporate Director Mar 27, 2018
Sheri Lindholm Individual Corporate Director Jul 1, 2020
Sonia Martinez Individual Corporate Director Jun 1, 2020
Judy Wagner Individual Corporate Director Jul 1, 2020
Julieta Barraza Individual Corporate Director Jul 1, 2020
Craig Harris Individual Corporate Director Aug 1, 2021
St. Jude Neighborhood Health Centers Organization, Fullerton, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2015 100%
Daniel Estrada Individual Corporate Director May 1, 2015
Maureen Sundberg Individual Corporate Director Aug 1, 2021
Mark Jablonski Individual Corporate Director Apr 1, 2020
Gloria Dominguez Colazo Individual Corporate DirectorBoard Member Apr 1, 2013
Juan Garcia Individual Corporate Director Jun 1, 2016
Timothy Jason Brown Individual Corporate OfficerCeo Oct 22, 2012
W-2 Managing EmployeeCeo Oct 22, 2012
Cecilia Bustamante-Pixa Individual Corporate Director Mar 1, 2020
Ronald R Diluigi Individual Corporate Director Jul 1, 2015
Sylvia Reyes Individual Corporate Director Mar 27, 2018
Sandra Even Individual Corporate Director Jan 1, 2015

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
St. Jude Neighborhood Health CentersFullerton, CA, CCN 751048 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 25, 2011
St. Jude Neighborhood Health CentersSanta Ana, CA, CCN 751172 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 4, 2015
R1 RCMOrange, CA, CCN 921100 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2018
St. Mary Health Centers - AdelantoAdelanto, CA, CCN A01062 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 24, 2020
St. Mary Health Centers - AvApple Valley, CA, CCN A01063 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 24, 2020

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

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

NPI Registry JSON

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1457742447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 S HIGHLAND AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928322753",
            "telephone_number": "714-446-5230",
            "fax_number": "714-449-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3232 TOPAZ LN",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928312609",
            "telephone_number": "714-446-5230",
            "fax_number": "714-449-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE NEIGHBORHOOD HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-11",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "208-899-9631"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "550000408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Topaz Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Topaz Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.