NPIMap

Organization Active NPI

Sac Health System

  • Federally Qualified Health Center (FQHC)
  • Blythe, CA
National Provider Identifier
1477212249
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAC HEALTH SYSTEM
Practice address
322 W Hobsonway
Blythe, CA 92225-1652
Phone
(909) 382-7100
NPI assigned
Dec 9, 2021
Last updated
Apr 21, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
SAC HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Authorized official

Name
Tasha Amick
Title
Director of Billing
Phone
(909) 382-7100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU

Addresses

Primary practice location

322 W Hobsonway
Blythe, CA 92225-1652

Mailing address

250 S G St
San Bernardino, CA 92410-3320
Phone (909) 382-7100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230106001448 CA Part A Provider - Federally Qualified Health Center (FQHC) 4385533579 Practice locations: Blythe, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477212249. Details of each certification follow.

Federally qualified health center certification: CCN A01141

Legal name
SAC HEALTH SYSTEM
Doing business as
SAC BLYTHE MEDICAL AND BEHAVIORAL HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 2022
Last certification
Dec 8, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 18, 1995 in CA
Enrollment address
322 W Hobsonway
Blythe, CA 92225-1640

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Sac Health System Norto18 organizations share this tax ID, including this one
Part of
Sac Health System Norto

Other organizations with this tax ID 17

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

View all 17

Locations

322 W Hobsonway
Blythe, CA 92225
Phone (619) 922-9101

Ownership & related parties

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
Peter J Baker Individual Corporate Director Feb 22, 2022
Angela Teresi Individual W-2 Managing Employee Jun 29, 2015
Jason Lohr Individual Corporate OfficerCeo Jun 29, 2018
Eric Ngo Individual Corporate OfficerSecretary Mar 1, 2010
Corporate Director Mar 1, 2010
Pat Morris Individual Corporate Director Sep 24, 2019
Raul Castillo Individual Corporate Director Apr 1, 2014
Richard Henry Hart Individual Corporate Director Jul 1, 2014
Edith Ann Atkinson Individual Corporate Director Mar 1, 2010
Rodney Neal Individual Corporate OfficerChair of the Board Sep 1, 2014
Corporate Director Sep 1, 2014
John B Skelton Individual Corporate OfficerCfo Apr 8, 2019
Jessica Garcia Individual Corporate Director Feb 22, 2022
Marilyn Hermann Individual Corporate Director Mar 1, 2010
Ken Ramirez Individual Corporate Director Jan 26, 2021

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745193600000",
    "number": "1477212249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 S G ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924103320",
            "telephone_number": "909-382-7100",
            "fax_number": "909-382-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "322 W HOBSONWAY",
            "city": "BLYTHE",
            "state": "CA",
            "postal_code": "922251652",
            "telephone_number": "909-382-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAC HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAC HEALTH SYSTEM",
        "enumeration_date": "2021-12-09",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A",
        "authorized_official_last_name": "AMICK",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "909-382-7100"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blythe, CA

Sources for this page

Verify at the official NPI Registry.