St. Jude Neighborhood Health Centers

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

ST. JUDE NEIGHBORHOOD HEALTH CENTERS

Practice address

330 E. Orangewood Ave
Anaheim, CA 92802

Phone

(714) 446-5100

NPI assigned

May 20, 2021

Organization subpart

No

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

Authorized official

Name

Timothy Jason Brown

Title

Ceo

Phone

(208) 899-9631

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Federally qualified health center certification: CCN A01059

Legal name

PONDEROSA HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 22, 2022

Last certification

Feb 22, 2022

Ownership / control type

For profit – corporation

Facility address

330 E Orangewood Ave
Anaheim, CA 92802

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• St. Jude Neighborhood Health Centers

  • Primary Care Clinic/Center
  • Adelanto, CA
  • NPI 1578198727

  Member Of

  NPD member

Locations

Practitioners 1

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

• Andrea Paz, LCSW

  • Clinical Social Worker
  • Fullerton, CA
  • NPI 1891186003
  NPD (past)

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

{
    "created_epoch": "1621468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621468800000",
    "number": "1487229787",
    "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": "714-446-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 E. ORANGEWOOD AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "92802",
            "telephone_number": "714-446-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE NEIGHBORHOOD HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-20",
        "last_updated": "2021-05-20",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-899-9631"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Joseph Health System Home Care Services
• St. Joseph Health System Home Care Services LLC
• St. Joseph Health System Home Care Services LLC
• St. Jude Hospital Yorba Linda
• St. Jude Neighborhood Health Centers
• Tristyn Veronique St. Thomas-Achoja
• Ryan St.Clair
• David Wayne Stadler II, SUDCC II #10096
• Courtney Stafford
• Massi Stahr, SLPA

• Federally Qualified Health Center (FQHC) in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.