NPIMap

Organization Active NPI

County of Santa Cruz

  • Federally Qualified Health Center (FQHC)
  • Santa Cruz, CA
National Provider Identifier
1578680310
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COUNTY OF SANTA CRUZ
Practice address
1080 Emeline Ave
Santa Cruz, CA 95060-1966
Phone
(831) 454-4100
Fax
(831) 454-4296
NPI assigned
Mar 26, 2007
Last updated
Nov 28, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF SANTA CRUZAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Authorized official

Name
Amy Peeler
Title
Chief of Clinics
Phone
(831) 454-4764

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Adult Mental Health Clinic/Center 261QM0850X CA
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU

Addresses

Primary practice location

1080 Emeline Ave
Santa Cruz, CA 95060-1966

Mailing address

1080 Emeline Ave
Santa Cruz, CA 95060-1966
Phone (831) 454-4100

Other identifiers 4

IdentifierTypeStateIssuer
HAP70042FOtherCASTATE - FAMILY PLANNING
1659315430OtherCALEGAL ENTITY NPI
BCP70042FOtherCACANCER DETECTION PROGRM
FHC70042FMedicaidCA

Other names 1

  • County of Santa Cruz Health Services Agency FQHC Santa Cruz Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031201000370 CA Part B Supplier - Clinic/Group Practice 7618872912 Receives reassigned benefits from 47 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Cruz, CA
O20031201000402 CA Part B Supplier - Clinic/Group Practice 7618872912 Receives reassigned benefits from 56 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Cruz, CA; Watsonville, CA
O20140630001795 CA Part A Provider - Federally Qualified Health Center (FQHC) 7618872912 Practice locations: Santa Cruz, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578680310. Details of each certification follow.

Federally qualified health center certification: CCN 751075

Legal name
COUNTY OF SANTA CRUZ
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 30, 2014
Last certification
Jun 30, 2014
Ownership / control type
Non-profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
1080 Emeline Ave
Santa Cruz, CA 95060-1966

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Santa Cruz County

Locations

1080 Emeline Ave
Rm 104
Santa Cruz, CA 95060
Phone (831) 454-4100

1430 Freedom Blvd
Watsonville, CA 95076
Phone (831) 763-8400

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Amy Peeler Individual 5% Or Greater Indirect Ownership Interest May 26, 2018
Corporate Director May 26, 2018
W-2 Managing Employee May 26, 2018
County of Santa Cruz Organization, Santa Cruz, CA Operational/Managerial Control May 1, 2014 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
County of Santa CruzWatsonville, CA, CCN 751076 Federally qualified health center Operational/Managerial Control (100%) May 1, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • County of Santa Cruz

    dba Watsonville Health Center

    • Federally Qualified Health Center (FQHC)
    • Watsonville, CA
    • NPI 1770709149

    Operational/Managerial Control

    CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1578680310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601966",
            "telephone_number": "831-454-4100",
            "fax_number": "831-454-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601966",
            "telephone_number": "831-454-4100",
            "fax_number": "831-454-4296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SANTA CRUZ",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF SANTA CRUZ",
        "enumeration_date": "2007-03-26",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "PEELER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CHIEF OF CLINICS",
        "authorized_official_telephone_number": "831-454-4764"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE - FAMILY PLANNING",
            "identifier": "HAP70042F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGAL ENTITY NPI",
            "identifier": "1659315430",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CANCER DETECTION PROGRM",
            "identifier": "BCP70042F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70042F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "County of Santa Cruz Health Services Agency FQHC Santa Cruz Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "County of Santa Cruz Health Services Agency FQHC Santa Cruz Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Cruz, CA

Sources for this page

Verify at the official NPI Registry.