NPIMap

Organization Active NPI

Community Medical Centers, Inc

Doing business as Community Medical Centers, Dorothy L. Jones

  • Federally Qualified Health Center (FQHC)
  • Stockton, CA
National Provider Identifier
1558726786
Registry record updated Nov 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY MEDICAL CENTERS, INC
Doing business as
Community Medical Centers, Dorothy L. Jones
Practice address
2044 Fair St
Stockton, CA 95206-2313
Phone
(209) 944-4700
NPI assigned
Dec 14, 2015
Last updated
Nov 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2016

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

Authorized official

Name
Mrs. Christine C Noguera
Title
Ceo
Phone
(209) 373-2831

Specialties & licenses 1

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

Addresses

Primary practice location

2044 Fair St
Stockton, CA 95206-2313

Mailing address

7210 Murray Dr
Stockton, CA 95210-3339
Phone (209) 373-2800

Other names 1

  • Community Medical Centers, Dorothy L. Jones Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160622001972 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426968520 Practice locations: Stockton, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558726786. Details of each certification follow.

Federally qualified health center certification: CCN 751893

Legal name
COMMUNITY MEDICAL CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 27, 2016
Last certification
Apr 27, 2016
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 9, 1978 in CA
Enrollment address
2044 Fair St
Stockton, CA 95206-2313

Other NPIs with the same Medicare PAC ID 24

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 24

National Provider Directory

National Provider Directory
Tax ID family
CMC Inc Dixon Family PR65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2044 Fair St
Stockton, CA 95206
Phone (209) 420-3138

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Ruby V King Individual Corporate DirectorBoard Member Jul 1, 2018
Jaime DG Allen Individual Corporate OfficerCfo Jan 1, 2019
Lily Aman Individual Corporate DirectorBoard Member Jul 1, 1989
Robert Smith Individual Corporate DirectorBoard Member Jul 1, 2013
Pamela Maffei Individual Corporate DirectorBoard Member Jul 1, 2011
Dora Vivero Individual W-2 Managing EmployeeDirector of Revenue Cycle Jan 1, 2019
Christine C Noguera Individual Corporate OfficerCeo Jul 1, 2014
Jasmine Leek Individual Corporate DirectorBoard Member Jul 1, 2015
Martha Robles Individual Corporate DirectorBoard Member Jul 1, 2019
Roger Speed Individual Corporate DirectorBoard Member Jul 1, 2004
Peter W Ragsdale Individual Corporate DirectorBoard Member Jul 1, 2018
Martha Dukes Individual Corporate DirectorBoard Member Jul 1, 1985

Practitioners & affiliated clinicians

Practitioners 4

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": "1450051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479513600000",
    "number": "1558726786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210 MURRAY DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103339",
            "telephone_number": "209-373-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2044 FAIR ST",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952062313",
            "telephone_number": "209-944-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-14",
        "last_updated": "2016-11-19",
        "status": "A",
        "authorized_official_last_name": "NOGUERA",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-373-2831",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Centers, Dorothy L. Jones",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.