NPIMap

Organization Active NPI

Ole Health

  • Federally Qualified Health Center (FQHC)
  • Fairfield, CA
National Provider Identifier
1497130280
Registry record updated Nov 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OLE HEALTH
Practice address
470 Chadbourne Rd
Suite a
Fairfield, CA 94534
Phone
(707) 254-1774
Fax
(707) 251-2988
NPI assigned
Jul 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2019

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

Authorized official

Name
Ms. Alicia Hardy
Title
Chief Executive Officer
Phone
(707) 254-1774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

470 Chadbourne Rd
Suite a
Fairfield, CA 94534

Mailing address

1141 Pear Tree LN Ste 100
Napa, CA 94558-6485
Phone (707) 254-1770

Other names 1

  • Community Health Clinic OLE Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040427001735 CA Part B Supplier - Clinic/Group Practice 7315934767 Receives reassigned benefits from 134 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Napa, CA; Saint Helena, CA; Fairfield, CA; Calistoga, CA; American Canyon, CA
O20160105001886 CA Part A Provider - Federally Qualified Health Center (FQHC) 7315934767 Practice locations: Fairfield, CA

Federally qualified health center certification: CCN 751195

Legal name
OLE HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 9, 2015
Last certification
Dec 9, 2015
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Oct 19, 1972 in CA
Enrollment address
470 Chadbourne Rd
Ste a
Fairfield, CA 94534-9620

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
Ole Health22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Peter Richmond Individual Corporate DirectorBoard Member Jul 17, 2019
Madeline Hernandez Individual Corporate DirectorBoard Member Jul 17, 2019
Flora R Asuncion Individual Corporate OfficerCoo Mar 16, 2022
Dawnielle Thornburgh Individual Corporate DirectorBoard Member Jul 17, 2019
Deborah Goodin Individual Corporate DirectorBoard Member Mar 11, 2022
Joseph Manuel Carrillo Individual Corporate DirectorBoard Member Jul 17, 2019
Ebon Richard Jones Individual Corporate DirectorBoard Member Jul 17, 2019
Maira Ayala Individual Corporate DirectorBoard Member Jul 17, 2019
Exa Johanna Moore Individual Corporate DirectorBoard Member Jul 17, 2019
Brandy Lane Individual Corporate DirectorBoard Member Mar 11, 2022
Beatrice Labastida Individual Corporate DirectorBoard Member Jul 17, 2019
Cynthia Macias Individual Corporate DirectorBoard Member Mar 11, 2022
Teresa Lynn Shinder Individual Corporate OfficerCmo Nov 11, 2019
Arthur Roosa Individual Corporate DirectorBoard Member Jul 17, 2019
Patricia McFarland Individual Corporate DirectorBoard Member Jul 17, 2019
Gary Fedler Individual Corporate OfficerCio Aug 15, 2019
Monin Martin Individual Corporate DirectorBoard Member Mar 11, 2022
Cephas Mugerwa Individual Corporate DirectorBoard Member Mar 11, 2022
Andrew Torge Individual Corporate OfficerChro Apr 13, 2020
Bryan Nazario Individual Corporate DirectorBoard Member Mar 11, 2022
Lori Wilson Individual Corporate DirectorBoard Member Mar 11, 2022
Anna Roth Individual Corporate DirectorBoard Member Mar 11, 2022
Alicia F Hardy Individual Corporate Officer Jan 8, 2018
W-2 Managing Employee Jan 8, 2018

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Ole HealthFairfield, CA, CCN 921815 Federally qualified health center Operational/Managerial Control (100%) Sep 14, 2018

Owned or controlled facilities with NPI records 1

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

  • Ole Health
    • Federally Qualified Health Center (FQHC)
    • Fairfield, CA
    • NPI 1316429558

    Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573776000000",
    "number": "1497130280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 PEAR TREE LN STE 100",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945586485",
            "telephone_number": "707-254-1770",
            "fax_number": "707-254-1779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 CHADBOURNE RD",
            "address_2": "SUITE A",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "94534",
            "telephone_number": "707-254-1774",
            "fax_number": "707-251-2988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-22",
        "last_updated": "2019-11-15",
        "status": "A",
        "authorized_official_last_name": "HARDY",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "707-254-1774",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Clinic OLE",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Community Health Clinic OLE",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fairfield, CA

Sources for this page

Verify at the official NPI Registry.