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Community Health Centers of the Central Coast, Inc

Organization Active NPI Community Health Clinic/Center · Arroyo Grande, CA

NPI 1598064008 · NPPES record last updated Jan 23, 2019

Key facts

NPI
1598064008
Entity type
Organization (NPI type 2)
Primary specialty
Community Health Clinic/Center 261QC1500X
Legal business name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC
Practice address
260 Station Way
Arroyo Grande, CA 93420-3359
Phone
(805) 473-6201
Fax
(805) 473-6291
NPI assigned
Mar 23, 2011
Organization subpart
No

Authorized official

Name
Barbara Allen
Title
Business Office Manager
Phone
(805) 361-8014

Other NPIs on the same Medicare enrollment 27

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

View all 27

Other NPIs with the same Medicare PAC ID 22

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

Corporate family (same tax ID) 21

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

Practitioners 78

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 78

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

Federally qualified health center certification: CCN 551158

Legal name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 28, 2012
Last certification
Mar 28, 2012
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
May 8, 1978 in CA
Enrollment address
260 Station Way
Arroyo Grande, CA 93420-3359

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Bertha Campos
Individual 		Corporate Director
Board Member		 May 1, 2020
Ronald E Castle
Individual 		Corporate Officer
Chief Executive Officer		 Jun 1, 1978 20%
W-2 Managing Employee Jun 1, 1978 100%
Barbara a Allen
Individual 		W-2 Managing Employee
Busniess Office Manager		 Jul 1, 1978 5%
William Gordon
Individual 		Corporate Director
Board President		 May 1, 2020

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040115001161 CA Part B Supplier - Clinic/Group Practice 7416868120 Receives reassigned benefits from 236 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Maria, CA; Paso Robles, CA; San Luis Obispo, CA; Templeton, CA; Oceano, CA; Arroyo Grande, CA; Atascadero, CA; Cambria, CA…
O20120328000443 CA Part a Provider - Federally Qualified Health Center (FQHC) 7416868120 Practice locations: Arroyo Grande, CA

National Provider Directory

Tax ID family
Comm HLTH CTRS of the C (22 organizations share this tax ID)

Locations

260 Station Way
Arroyo Grande, CA 93420
Phone (805) 473-6201

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD
    Plans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Yes

Addresses

Primary practice location

260 Station Way
Arroyo Grande, CA 93420-3359

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458
Phone (805) 361-8014

Other names

  • Community Health Centers-Arroyo Grande Doing business as

Other providers in Arroyo Grande, CA

All providers in Arroyo Grande, CA · Community Health Clinic/Center in California

Sources for this page

Verify at the official NPI Registry.