NPIMap

Organization Active NPI

Indian Health Center of Santa Clara Valley

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1538529052
Registry record updated Feb 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
070000118 Issued in CA
Legal business name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Practice address
25 N 14TH St Ste 140
San Jose, CA 95112-6218
Phone
(408) 445-3400
Fax
(408) 448-1727
NPI assigned
Feb 25, 2016
Last updated
Feb 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2016

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

Authorized official

Name
Dr. Aldon Wayne Scott, DOCTOR OF MANAGEMENT
Title
Director of Operations
Phone
(408) 445-3400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 070000118 CA Primary
Adult Mental Health Clinic/Center 261QM0850X 070000482 CA

Addresses

Primary practice location

25 N 14TH St Ste 140
San Jose, CA 95112-6218

Mailing address

1333 Meridian Ave
San Jose, CA 95125-5212
Phone (408) 445-3400

Other identifiers 4

IdentifierTypeStateIssuer
FHC11833FMedicaidCA
FHC11833FOtherCAMEDI-CAL
55-1137OtherCAMEDICARE PALMETTO
FHC11833FOtherCASTATE PROGRAM

Other names 1

  • Indian Health Center of Santa Clara Valley - FRC Other name

National Provider Directory

National Provider Directory
Tax ID family
Indian Health Ctr SC14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

25 N 14th St
Ste 140
San Jose, CA 95112

Practitioners & affiliated clinicians

Practitioners 6

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": "1456358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456358400000",
    "number": "1538529052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MERIDIAN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255212",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 N 14TH ST STE 140",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951126218",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-25",
        "last_updated": "2016-02-25",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "ALDON",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "408-445-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DOCTOR OF MANAGEMENT"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "070000118",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "070000482",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC11833F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "FHC11833F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PALMETTO",
            "identifier": "55-1137",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROGRAM",
            "identifier": "FHC11833F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Health Center of Santa Clara Valley - FRC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.