NPIMap

Organization Active NPI

Community Medical Centers Inc

Doing business as Community Medical Centers, Tracy Dental

  • Federally Qualified Health Center (FQHC)
  • Tracy, CA
National Provider Identifier
1497261606
Registry record updated Dec 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY MEDICAL CENTERS INC
Doing business as
Community Medical Centers, Tracy Dental
Practice address
2135 N Tracy Blvd
Tracy, CA 95376-2424
Phone
(209) 373-2800
NPI assigned
Dec 26, 2017
Last updated
Dec 26, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2017

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

Authorized official

Name
Mrs. Christine Noguera
Title
Ceo
Phone
(209) 373-2831

Specialties & licenses 1

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

Addresses

Primary practice location

2135 N Tracy Blvd
Tracy, CA 95376-2424

Mailing address

7210 Murray Dr
Stockton, CA 95210-3339
Phone (209) 373-2800

Other names 1

  • Community Medical Centers, Tracy Dental Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180403002209 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426968520 Practice locations: Tracy, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497261606. Details of each certification follow.

Federally qualified health center certification: CCN 921051

Legal name
COMMUNITY MEDICAL CENTERS, INC.
Doing business as
COMMUNITY MEDICAL CENTERS, TRACY DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 29, 2018
Last certification
Mar 29, 2018
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 9, 1978 in CA
Enrollment address
2135 N Tracy Blvd
Tracy, CA 95376-2424

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Woodridge Medical GRP65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2135 N Tracy Blvd
Tracy, CA 95376
Phone (209) 636-5555

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Ruby V King Individual Corporate DirectorBoard Member May 23, 2018
Jaime DG Allen Individual Corporate OfficerCfo Jan 1, 2019
Lily Aman Individual Corporate DirectorBoard Member Jul 1, 1989
Robert Smith Individual Corporate DirectorBoard Member Jul 1, 2013
Gregory a Deiderich Individual Corporate OfficerCeo Nov 1, 2024
Pamela Maffei Individual Corporate DirectorBoard Member Jul 1, 2011
Pandora J Crowder Individual Corporate DirectorBoard Member Jun 27, 2021
Dora Vivero Individual W-2 Managing EmployeeRevenue Cycle Director Mar 23, 2018
Colleen H Ustach Individual Corporate DirectorBoard Member Apr 23, 2024
Leona Jewnell Rodgers Individual Corporate DirectorBoard Member Jul 23, 2024
Jasmine Leek Individual Corporate DirectorBoard Member Jul 1, 2015
Martha Robles Individual Corporate DirectorBoard Member Jan 23, 2019
Peter W Ragsdale Individual Corporate DirectorBoard Member May 23, 2018
Martha Dukes Individual Corporate DirectorBoard Member Jul 1, 1985

NPI Registry JSON

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

{
    "created_epoch": "1514246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514246400000",
    "number": "1497261606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210 MURRAY DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103339",
            "telephone_number": "209-373-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2135 N TRACY BLVD",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953762424",
            "telephone_number": "209-373-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-26",
        "last_updated": "2017-12-26",
        "status": "A",
        "authorized_official_last_name": "NOGUERA",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-373-2831",
        "authorized_official_name_prefix": "Mrs."
    },
    "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 Medical Centers, Tracy Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tracy, CA

Sources for this page

Verify at the official NPI Registry.