NPIMap

Organization Active NPI

M a C T Health Board, Incorporated

  • Federally Qualified Health Center (FQHC)
  • Bear Valley, CA
National Provider Identifier
1508724337
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Jan 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Authorized official

Name
John Shawver Alexander
Title
Executive Director
Phone
(209) 754-6258

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

367 Creekside Dr
Bear Valley, CA 95223-9455

Mailing address

PO Box 939
Angels Camp, CA 95222-0939

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508724337. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
367 Creekside Dr
Bear Valley, CA 95223-9455

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
M a C T Health Board Incorp17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
John Alexander Individual Corporate OfficerExecutive Director Sep 10, 2012
W-2 Managing EmployeeAd; Sep 10, 2012
Justin Baugh Individual Corporate DirectorBoard Chair Jun 26, 2017
George Gurion Individual Corporate DirectorBoard Vice Chair Apr 22, 2023
Carolyn Sayers Individual Corporate DirectorBoard Secretary Jun 3, 2025
Mariela Contreras Individual Corporate OfficerFinance/Deputy Executive Director Feb 2, 2015
W-2 Managing EmployeeAd; Feb 2, 2015
Nancy Ehlers Individual Corporate DirectorBoard Treasurer Jan 21, 2019
M a C T Health Board Incorporated Organization, Angels Camp, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 21, 1979 100%

Owners & managing parties with NPI records 6

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

NPI Registry JSON

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

{
    "created_epoch": "1768176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768435200000",
    "number": "1508724337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 939",
            "city": "ANGELS CAMP",
            "state": "CA",
            "postal_code": "952220939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 CREEKSIDE DR",
            "city": "BEAR VALLEY",
            "state": "CA",
            "postal_code": "952239455",
            "telephone_number": "209-674-6198",
            "fax_number": "209-674-6272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M A C T HEALTH BOARD, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-12",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "SHAWVER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-754-6258"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bear Valley, CA

Sources for this page

Verify at the official NPI Registry.