M a C T Health Board, Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · Bear Valley, CA
NPI 1508724337 · NPPES record last updated Jan 15, 2026
Key facts
- NPI
- 1508724337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- M A C T HEALTH BOARD, INCORPORATED
- Practice address
- 367 Creekside Dr
Bear Valley, CA 95223-9455 - Phone
- (209) 674-6198
- Fax
- (209) 674-6272
- NPI assigned
- Jan 12, 2026
- Organization subpart
- No
Authorized official
- Name
- John Shawver Alexander
- Title
- Executive Director
- Phone
- (209) 754-6258
Owners & managing parties with NPI records 6
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 12
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Federally qualified health center certification: CCN A11052
- Legal name
- M A C T HEALTH BOARD INCORPORATED
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 19, 2026
- Last certification
- Feb 19, 2026
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 367 Creekside Dr
Bear Valley, CA 95223-9455
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| John Alexander |
Corporate Officer |
Sep 10, 2012 | |
| W-2 Managing Employee |
Sep 10, 2012 | ||
| Justin Baugh |
Corporate Director |
Jun 26, 2017 | |
| George Gurion |
Corporate Director |
Apr 22, 2023 | |
| Carolyn Sayers |
Corporate Director |
Jun 3, 2025 | |
| Mariela Contreras |
Corporate Officer |
Feb 2, 2015 | |
| W-2 Managing Employee |
Feb 2, 2015 | ||
| Nancy Ehlers |
Corporate Director |
Jan 21, 2019 | |
| M a C T Health Board Incorporated |
5% Or Greater Direct Ownership Interest | Sep 21, 1979 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260519003010 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 8325936974 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bear Valley, CA |
National Provider Directory
- Tax ID family
- Mact Health Board Incorporated
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
367 Creekside Dr
Bear Valley, CA 95223-9455
Mailing address
PO Box 939
Angels Camp, CA 95222-0939
Other providers in Bear Valley, CA
- Alpine County Bear V Alley
- Alpine County Behavioral Health Services
- BV Parents Group, Inc.
- Kimi Johnson
All providers in Bear Valley, 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 Jan 15, 2026. 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.