NPIMap

Organization Active NPI

Centro de Salud de la Comunidad de San Ysidro, Inc.

Doing business as San Ysidro Health Paradise Hills

  • Federally Qualified Health Center (FQHC)
  • National City, CA
National Provider Identifier
1598907487
Registry record updated Nov 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001126 Issued in CA
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
San Ysidro Health Paradise Hills
Practice address
2400 E 8TH St
Suite # a
National City, CA 91950-2956
Phone
(619) 662-4100
Fax
(619) 205-6373
NPI assigned
Mar 24, 2009
Last updated
Nov 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2018

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

Authorized official

Name
Kevin Mattson
Title
President and Ceo
Phone
(619) 662-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550001126 CA Primary

Addresses

Primary practice location

2400 E 8TH St
Suite # a
National City, CA 91950-2956

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 662-4100

Other names 1

  • San Ysidro Health Paradise Hills Doing business as

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040130000711 CA Part B Supplier - Clinic/Group Practice 6901709435 Receives reassigned benefits from 611 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: National City, CA; San Diego, CA; San Ysidro, CA; Santee, CA; Vista, CA; Alpine, CA; Campo, CA; Chula Vista, CA…
O20091021000294 CA Part A Provider - Federally Qualified Health Center (FQHC) 6901709435 Practice locations: National City, CA
O20191023003400 CA MDPP Supplier - in-Person MDPP Supplier 6901709435 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Diego, CA; San Ysidro, CA; National City, CA; Chula Vista, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598907487. Details of each certification follow.

Federally qualified health center certification: CCN 551004

Legal name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.
Doing business as
SAN YSIDRO HEALTH PARADISE HILLS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 21, 2009
Last certification
Oct 21, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1971 in CA
Enrollment address
2400 E 8TH St
Ste a
National City, CA 91950-2956

Other NPIs on the same Medicare enrollment 40

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

View all 40

National Provider Directory

National Provider Directory
Tax ID family
Chula Vista Family52 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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Tomas Urtasun Individual Corporate DirectorBoard Member Apr 1, 2010
Guillermo Gomez Individual Corporate DirectorBoard Member Oct 20, 2012
Magdalena Peraza Individual Corporate DirectorBoard Member Jul 7, 1997
Catalina Valencia Individual Corporate DirectorBoard Member Oct 28, 2017
William Wallace Individual Corporate OfficerCfo Nov 1, 2019
Victor Nieto Individual Corporate DirectorBoard Member Jan 27, 1999
Reynaldo Perez Individual Corporate DirectorBoard Member Apr 1, 1995
Michael Dew Individual W-2 Managing EmployeeDirector of Managed Care Dec 1, 2021
Terry Whitaker Individual Corporate DirectorBoard Member Aug 24, 2009
W-2 Managing Employee Aug 24, 2009
Sergio Cuevas Individual Corporate OfficerCdo Aug 24, 2009
W-2 Managing EmployeeCoo Aug 24, 2009
Fred Dorsey Individual Corporate DirectorBoard Member Oct 21, 2016
Kusay I Arabo Individual Corporate DirectorBoard Member Aug 24, 2017
Gloria Ramirez Individual Corporate DirectorBoard Member Aug 4, 1994
Paul Romayor Individual Corporate DirectorBoard Member Dec 22, 2021
Macario Gutierrez Individual Corporate Director Aug 24, 2009
Kevin Mattson Individual Corporate OfficerCeo/President Jul 1, 2002
Margarita Navarro Individual Corporate DirectorBoard Member Apr 3, 1997

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
San Ysidro Health CHC-Ocean ViewSan Diego, CA, CCN 551920 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2008
San Ysidro Health EuclidSan Diego, CA, CCN 551922 Federally qualified health center 5% Or Greater Direct Ownership Interest Aug 25, 2009
San Ysidro Health OtayChula Vista, CA, CCN 551966 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 5, 1971
San Ysidro Health San Diego Pace/Senior Health ServicesSan Ysidro, CA, CCN 751102 Federally qualified health center 5% Or Greater Direct Ownership Interest Sep 1, 2014
San Ysidro Health El Cajon/San Diego PaceEl Cajon, CA, CCN 751822 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2015
San Ysidro Health South BayNational City, CA, CCN 751950 Federally qualified health center 5% Or Greater Direct Ownership Interest (5%) Jun 1, 2016

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1237852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541548800000",
    "number": "1598907487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921731345",
            "telephone_number": "619-662-4100",
            "fax_number": "619-428-7952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 E 8TH ST",
            "address_2": "SUITE # A",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919502956",
            "telephone_number": "619-662-4100",
            "fax_number": "619-205-6373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-24",
        "last_updated": "2018-11-07",
        "status": "A",
        "authorized_official_last_name": "MATTSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "619-662-4100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Ysidro Health Paradise Hills",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Ysidro Health Paradise Hills",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in National City, CA

Sources for this page

Verify at the official NPI Registry.