NPIMap

Organization Active NPI

Ampla Health

  • Federally Qualified Health Center (FQHC)
  • Arbuckle, CA
National Provider Identifier
1497931828
Registry record updated Oct 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550000669 Issued in CA
Legal business name
AMPLA HEALTH
Practice address
89 Putnam Way
Arbuckle, CA 95912-9814
Phone
(530) 476-2200
Fax
(530) 476-2201
NPI assigned
Jan 16, 2008
Last updated
Oct 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2022

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) 751-3739

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550000669 CA Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

89 Putnam Way
Arbuckle, CA 95912-9814

Mailing address

935 Market St
Yuba City, CA 95991-4217
Phone (530) 751-3769

Other identifiers 1

IdentifierTypeStateIssuer
6517638MedicaidCA

Other names 1

  • AMPLA HEALTH ARBUCKLE MEDICAL & DENTAL 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…
O20090710000024 CA Part A Provider - Federally Qualified Health Center (FQHC) 5092619270 Practice locations: Arbuckle, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497931828. Details of each certification follow.

Federally qualified health center certification: CCN 551009

Legal name
AMPLA HEALTH
Doing business as
AMPLA HEALTH ARBUCKLE MEDICAL & DENTAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 10, 2009
Last certification
Jul 10, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1973 in CA
Enrollment address
89 Putnam Way
Arbuckle, CA 95912-9814

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
Richlands Family Health13 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.

Ownership & related parties

All disclosed owners & managing parties 10

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 and Chief Executive of Apr 1, 2009 100%
J Angel Calderon Individual Corporate DirectorBoard Member Jan 31, 2012
Roberto B Gonzalez Individual Corporate DirectorBoard Member Jan 30, 2007
Mark a Lundberg Individual Corporate DirectorBoard Member Apr 1, 2017
Teng Vang Individual Corporate DirectorBoard Member Jun 25, 2019
Horacio Paras Individual Corporate DirectorBoard Member Jun 10, 2013
Vicki L Chissie Individual W-2 Managing EmployeeBilling Manager Aug 21, 2013
Debbie D Porcayo Individual Corporate DirectorBoard Member Oct 27, 2009
Wenceslao Vasquez Individual Corporate DirectorBoard Member Jan 28, 2004

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665446400000",
    "number": "1497931828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "935 MARKET ST",
            "city": "YUBA CITY",
            "state": "CA",
            "postal_code": "959914217",
            "telephone_number": "530-751-3769",
            "fax_number": "530-751-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 PUTNAM WAY",
            "city": "ARBUCKLE",
            "state": "CA",
            "postal_code": "959129814",
            "telephone_number": "530-476-2200",
            "fax_number": "530-476-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMPLA HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2022-10-11",
        "certification_date": "2022-10-11",
        "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": "530-751-3739",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550000669",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6517638",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMPLA HEALTH ARBUCKLE MEDICAL & DENTAL",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "AMPLA HEALTH ARBUCKLE MEDICAL & DENTAL",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Arbuckle, CA

Sources for this page

Verify at the official NPI Registry.