NPIMap

Organization Active NPI

San Jose Foothill Family Community Clinic, Inc.

Doing business as Foothill Community Health Center

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1538508015
Registry record updated Jun 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC.
Doing business as
Foothill Community Health Center
Practice address
1066 South White Road
San Jose, CA 95127-3812
Phone
(408) 755-3800
Fax
(866) 931-7822
NPI assigned
Jun 18, 2013
Last updated
Jun 4, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2015

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

Authorized official

Name
Mr. Salvador Chavarin
Title
Chief Executive Officer
Phone
(408) 729-4290

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

1066 South White Road
San Jose, CA 95127-3812

Mailing address

2670 South White Road
Suite 200
San Jose, CA 95148-2071
Phone (408) 729-4290

Other names 1

  • Foothill Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Part of
San Jose Foothill Family

Locations

1066 S White Rd
San Jose, CA 95127
Phone (408) 755-3800

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jun 1, 2020 Change of OwnershipThis provider was the seller Bach Family ClinicCCN 751182, CA, NPI 1962024059

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 11

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": "1371513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433376000000",
    "number": "1538508015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 SOUTH WHITE ROAD",
            "address_2": "SUITE 200",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951482071",
            "telephone_number": "408-729-4290",
            "fax_number": "866-931-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1066 SOUTH WHITE ROAD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951273812",
            "telephone_number": "408-755-3800",
            "fax_number": "866-931-7822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN JOSE FOOTHILL FAMILY COMMUNITY CLINI",
        "enumeration_date": "2013-06-18",
        "last_updated": "2015-06-04",
        "status": "A",
        "authorized_official_last_name": "CHAVARIN",
        "authorized_official_first_name": "SALVADOR",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "408-729-4290",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foothill Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.