NPIMap

Organization Active NPI

Community Health Centers of the Central Coast, Inc

Doing business as Community Health Centers-Casa

  • Community Health Clinic/Center
  • San Luis Obispo, CA
National Provider Identifier
1629377452
Registry record updated Jan 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC
Doing business as
Community Health Centers-Casa
Practice address
77 Casa St Ste 201
San Luis Obispo, CA 93405-5806
Phone
(805) 269-1500
Fax
(805) 269-1585
NPI assigned
Mar 18, 2011
Last updated
Jan 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2019

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

Authorized official

Name
Mr. Ronald E Castle
Title
Chief Executive Officer
Phone
(805) 929-3211

Specialties & licenses 1

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

Addresses

Primary practice location

77 Casa St Ste 201
San Luis Obispo, CA 93405-5806

Mailing address

2050 S Blosser Rd
Santa Maria, CA 93458-7310
Phone (805) 361-8028

Other names 1

  • Community Health Centers-Casa Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

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…
O20141021000151 CA Part A Provider - Federally Qualified Health Center (FQHC) 7416868120 Practice locations: San Luis Obispo, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629377452. Details of each certification follow.

Federally qualified health center certification: CCN 751088

Legal name
COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 21, 2014
Last certification
Oct 21, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 4, 1978 in CA
Enrollment address
77 Casa St
San Luis Obispo, CA 93405-5803

Other NPIs with the same Medicare PAC ID 22

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

View all 22

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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 DirectorBoard Member Jun 1, 2010 5%
Ronald E Castle Individual Corporate OfficerChief Executive Officer May 1, 1978 15%
Barbara a Allen Individual Corporate OfficerBusiness Office Manager May 1, 1990 5%
W-2 Managing EmployeeBusiness Office Manager May 1, 1978 5%
Felicity Lazo Individual Corporate DirectorBoard Member Jan 10, 2010 5%
William Gordon Individual Corporate DirectorBoard of Directors Aug 1, 2011 5%

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1300406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548028800000",
    "number": "1629377452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 S BLOSSER RD",
            "city": "SANTA MARIA",
            "state": "CA",
            "postal_code": "934587310",
            "telephone_number": "805-361-8028",
            "fax_number": "805-361-8097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 CASA ST STE 201",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934055806",
            "telephone_number": "805-269-1500",
            "fax_number": "805-269-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF THE CENTRAL COAST, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-18",
        "last_updated": "2019-01-21",
        "status": "A",
        "authorized_official_last_name": "CASTLE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "805-929-3211",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Centers-Casa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Health Centers-Casa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.