Valley Health Team, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Bishop, CA
NPI 1508465303 · NPPES record last updated Oct 22, 2020
Key facts
- NPI
- 1508465303
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- VALLEY HEALTH TEAM, INC
- Practice address
- 459 W Line St Ste C
Bishop, CA 93514-3333 - Phone
- (760) 784-7020
- Fax
- (559) 326-5323
- NPI assigned
- Oct 22, 2020
- Organization subpart
- No
Authorized official
- Name
- Mrs. Soyla A. Reyna-Griffin, C.P.A.
- Title
- Chief Executive Officer
- Phone
- (559) 693-2462
Owners & managing parties with NPI records 11
-
Husam S. Kaileh, M.D.
Owned or controlled facilities with NPI records 8
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 10
Corporate family (same tax ID) 24
Facilities with the same owner 8
Practitioners 17
-
John Ted Djabrayan, M.D.
-
Ronald Eric Dominguez, M.D.
-
Arvin Sanchez Fuentes, M.D.
-
Husam S. Kaileh, M.D.
-
Yi Wang, MD
-
Satnam Singh Bangar, M.D.
-
Razan Husam Kaileh, DPM
-
Fi Dan Lo, MD
-
Sudhakar Nadipally, M.B.B.S.,M.P.H.,M.D.
-
Xeng Xai Xiong, MD
-
Maria Janette Jerardi, MD, MHS
-
Sy Sophamixay-Essegian, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 921958
- Legal name
- VALLEY HEALTH TEAM, INC.
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 28, 1973 in CA
- Enrollment address
- 459 W Line St
Ste C
Bishop, CA 93514-3333
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Ted Ang Avena |
W-2 Managing Employee |
Nov 13, 2017 | |
| Joann R Minnite |
Corporate Director |
May 16, 2002 | |
| Jose E Ramos |
Corporate Director |
Nov 16, 2000 | |
| Melissa Lopez |
W-2 Managing Employee |
Nov 13, 2017 | |
| Mary H Reynaga |
Corporate Director |
Jan 28, 1998 | |
| Valley Health Team, Inc. |
5% Or Greater Direct Ownership Interest | Mar 1, 2012 | 100% |
| Husam Salem Kaileh |
Corporate Officer |
Aug 1, 1995 | |
| Gurpriet S Sran |
Corporate Director |
Nov 20, 2014 | |
| Sean P Folweiler |
Corporate Officer |
Jun 5, 2017 | |
| Soyla a Reyna-Griffin |
Corporate Officer |
Nov 16, 2007 | 100% |
| Surjit Virdi |
Corporate Director |
Jul 25, 2013 | |
| Maggie J Rubio |
Corporate Director |
Jun 21, 2007 | |
| Jordana Ashley Dablan |
W-2 Managing Employee |
Dec 3, 2019 | |
| Sharon Ann Medigovich-Johnson |
Corporate Officer |
Aug 1, 1995 | |
| Craig J Knight |
Corporate Director |
Mar 31, 2016 | |
| Amirt Paul Brar |
Corporate Director |
Jan 20, 2011 | |
| Mary Ellen Pumarejo |
Corporate Director |
Feb 26, 2015 |
All facility ownership & control disclosures 8
| Facility | Type | Role | Since |
|---|---|---|---|
| Firebaugh Community Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Dec 1, 2022 Dec 1, 2022 |
| Kerman Unified School District Community Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 28, 1973 Jun 28, 1973 |
| Clovis Community Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 2, 2014 Jun 2, 2014 |
| Kingsburg Community Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 5, 2023 Jun 5, 2023 |
| Central Fresno Community Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Nov 13, 2017 Nov 13, 2017 |
| Dinuba Community Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 1, 2018 Sep 11, 2018 |
| Kerman Dental Center / Valley Optometric Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Mar 26, 2012 Mar 26, 2012 |
| Golden Plains Unified School District Community Health Center |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jun 29, 2020 Jun 29, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210505001566 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 2365588902 | Practice locations: Bishop, CA |
| O20220425001596 | CA | Part B Supplier - Clinic/Group Practice | 2365588902 |
Receives reassigned benefits from 9 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: San Joaquin, CA; Kingsburg, CA; Kerman, CA; Fresno, CA; Dinuba, CA; Clovis, CA; Bishop, CA; Firebaugh, CA |
National Provider Directory
- Tax ID family
- Valley Health Team Inc
Locations
927 O St
Firebaugh, CA 93622
Phone (209) 659-3037
121 W Sierra St
Kingsburg, CA 93631
Phone (559) 326-5320
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
459 W Line St Ste C
Bishop, CA 93514-3333
Mailing address
PO Box 737
San Joaquin, CA 93660-0737
Phone (559) 693-2462
Other names
- Bishop Community Health Center
Other providers in Bishop, CA
- Jessica Tucker
- James Tur
- Sheila J Turner
- Vacca,Morgan,Khosla,Leppla,Demers,Sekhon,& Blake, LTD
- Valley Health Team Inc
- Valley Health Team, Inc
- Jacey Van Dyk
- VCD Associates LLC
- Perla Vea Gastelum
- Jody Veenker
All providers in Bishop, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.