NPIMap

Organization Active NPI

Ampla Health

  • Federally Qualified Health Center (FQHC)
  • Colusa, CA
National Provider Identifier
1477586808
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
230000216 Issued in CA
Legal business name
AMPLA HEALTH
Practice address
555 Fremont St
Colusa, CA 95932-2534
Phone
(530) 458-8635
Fax
(530) 458-7830
NPI assigned
Jul 9, 2006
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Mr. Benjamin H Flores, MPH
Title
President, Chief Executive Officer
Phone
(530) 751-3778

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X 230000216 CA Primary
Case Manager/Care Coordinator 171M00000X

Addresses

Primary practice location

555 Fremont St
Colusa, CA 95932-2534

Mailing address

PO Box Ad
Yuba City, CA 95992-1396
Phone (530) 751-3778

Other identifiers 3

IdentifierTypeStateIssuer
6865328MedicaidCA
BCP70544FOtherCAEWC:CDP:BCEDP
HAP70544FOtherCAFAMILY PLANNING

Other names 1

  • AMPLA HEALTH COLUSA MEDICAL Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040225001116 CA Part B Supplier - Clinic/Group Practice 5092619270 Receives reassigned benefits from 154 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yuba City, CA; Chico, CA; Oroville, CA; Orland, CA; Olivehurst, CA; Los Molinos, CA; Hamilton City, CA; Gridley, CA…
O20060201000750 CA Part A Provider - Federally Qualified Health Center (FQHC) 5092619270 Practice locations: Colusa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477586808. Details of each certification follow.

Federally qualified health center certification: CCN 051989

Legal name
AMPLA HEALTH
Doing business as
AMPLA HEALTH COLUSA MEDICAL & DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 15, 1992
Last certification
Feb 15, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1973 in CA
Enrollment address
555 Fremont St
Colusa, CA 95932-2534

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 13

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

View all 13

National Provider Directory

National Provider Directory
Tax ID family
Rideout Memorial Hospit13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

89 Putnam Way
Arbuckle, CA 95912
Phone (530) 476-2200

931 Market St
Yuba City, CA 95991
Phone (530) 671-8820

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Kim D Owens Individual Corporate DirectorBoard Member Apr 27, 2007
Benjamin H Flores Individual Corporate OfficerPresident & Ceo Apr 1, 2009
J Angel Calderon Individual Corporate DirectorBoard Member Jan 31, 2012
Roberto B Gonzalez Individual Corporate DirectorBoard Member Jan 30, 2007
Teng Vang Individual Corporate DirectorBoard Member Jun 25, 2019
Horacio Paras Individual Corporate DirectorBoard Member Jun 1, 2013
Vicki L Chissie Individual W-2 Managing EmployeePatient Accounts Manager Mar 19, 2012
Debbie D Porcayo Individual Corporate DirectorBoard Member Oct 27, 2009
Wenceslao Vasquez Individual Corporate Director Jan 28, 2004

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1477586808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX AD",
            "city": "YUBA CITY",
            "state": "CA",
            "postal_code": "959921396",
            "telephone_number": "530-751-3778",
            "fax_number": "530-751-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 FREMONT ST",
            "city": "COLUSA",
            "state": "CA",
            "postal_code": "959322534",
            "telephone_number": "530-458-8635",
            "fax_number": "530-458-7830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMPLA HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT, CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "530-751-3778",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "230000216",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6865328",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EWC:CDP:BCEDP",
            "identifier": "BCP70544F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PLANNING",
            "identifier": "HAP70544F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMPLA HEALTH COLUSA MEDICAL",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "AMPLA HEALTH COLUSA MEDICAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Colusa, CA

Sources for this page

Verify at the official NPI Registry.