M a C T Health Board, Incorporated
Organization Active NPI Federally Qualified Health Center (FQHC) · San Andreas, CA
NPI 1528508488 · NPPES record last updated Jun 12, 2025
Key facts
- NPI
- 1528508488
- 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
- 1113A Highway 49
San Andreas, CA 95249 - Phone
- (209) 755-1460
- NPI assigned
- Feb 27, 2017
- Organization subpart
- No
Authorized official
- Name
- John Alexander
- Title
- Executive Director
- Phone
- (209) 754-6258
Other NPIs on the same Medicare enrollment 1
Practitioners 9
-
Nhu-Y Nguyen Chau, DMD
-
Cesar Clarin, DDS
-
Wenbo Lu, DDS
-
Christopher D Parker, D.D.S.
-
Patricia Rivas, DDS
-
Panida Sahasakmontri, DMD
-
Sharon Thao VI Tu, DMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
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
- Corporation · Non-profit
- Enrollment address
- 1113A Highway 49
San Andreas, CA 95249
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Justin Baugh |
Corporate Director |
Jun 26, 2017 | |
| George Gurion |
Corporate Director |
Apr 22, 2023 | |
| Mariela Contreras |
Corporate Director |
May 4, 2026 | |
| W-2 Managing Employee |
Feb 2, 2015 | ||
| Nancy Ehlers |
Corporate Director |
Jan 21, 2019 | |
| Alberta Sue Tasso |
Corporate Director |
Aug 6, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | |||
| Optometrist |
152W00000X | |||
| Case Manager/Care Coordinator |
171M00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
Other providers in San Andreas, CA
- Shannon M Linton
- Cynthia Ann Lopez
- Rebecca Rochelle Lopez
- M a C T Health Board Incorporated
- M a C T Health Board, Incorporated
- Heather Nicole Mack
- Pilar Majors
- Mark Twain Medical Center
- Mark Twain Medical Center
- Mark Twain Medical Center
All providers in San Andreas, 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 Jun 12, 2025. 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.