NPIMap

Organization Active NPI

M a C T Health Board, Incorporated

  • Federally Qualified Health Center (FQHC)
  • San Andreas, CA
National Provider Identifier
1528508488
Registry record updated Jun 12, 2025
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
1113A Highway 49
San Andreas, CA 95249
Phone
(209) 755-1460
NPI assigned
Feb 27, 2017
Last updated
Jun 12, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2025

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

Authorized official

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1113A Highway 49
San Andreas, CA 95249

Mailing address

PO Box 939
Angels Camp, CA 95222-0939
Phone (209) 754-6262

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250818000554 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: San Andreas, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528508488. Details of each certification follow.

Federally qualified health center certification: CCN A01960

Legal name
M A C T HEALTH BOARD INCORPORATED
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 16, 2025
Last certification
May 16, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1113A Highway 49
San Andreas, CA 95249

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

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Justin Baugh Individual Corporate DirectorBoard Chair Jun 26, 2017
George Gurion Individual Corporate DirectorBoard Member Apr 22, 2023
Mariela Contreras Individual Corporate DirectorExecutive Director May 4, 2026
W-2 Managing EmployeeExecutive Director Feb 2, 2015
Nancy Ehlers Individual Corporate DirectorBoard Member Jan 21, 2019
Alberta Sue Tasso Individual Corporate DirectorBoard/Corporate Secretary Aug 6, 2018

Practitioners & affiliated clinicians

Practitioners 9

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": "1488153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1528508488",
    "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",
            "telephone_number": "209-754-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1113A HIGHWAY 49",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "95249",
            "telephone_number": "209-755-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M A C T HEALTH BOARD, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-27",
        "last_updated": "2025-06-12",
        "certification_date": "2025-06-12",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "209-754-6258"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "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 San Andreas, CA

Sources for this page

Verify at the official NPI Registry.