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Ampla Health

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

NPI 1477586808 · NPPES record last updated Feb 29, 2024

Key facts

NPI
1477586808
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
License
230000216 (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
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 1

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

  • Teng Vang, LMFT Marriage & Family Therapist · Oroville, CA · NPI 1861552705
    CMS ownership CORPORATE DIRECTOR

Other NPIs on the same Medicare enrollment 13

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

Other NPIs with the same Medicare PAC ID 16

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

Corporate family (same tax ID) 12

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

Practitioners 109

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

View all 109

Medicare participation

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

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
Corporation · Non-profit
Incorporated
Jun 5, 1973 in CA
Enrollment address
555 Fremont St
Colusa, CA 95932-2534

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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Ampla Health Chico Pharmacy (13 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator
Group: 193200000X MULTI-SPECIALTY GROUP		 171M00000X
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X 230000216 CA Yes

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

IdentifierTypeStateIssuer
HAP70544FOtherCAFAMILY PLANNING
6865328MedicaidCA
BCP70544FOtherCAEWC:CDP:BCEDP

Other names

  • AMPLA HEALTH COLUSA MEDICAL Other name

Other providers in Colusa, CA

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

Sources for this page

Verify at the official NPI Registry.