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Sac Health System

Organization Active NPI Federally Qualified Health Center (FQHC) · San Bernardino, CA

NPI 1649547944 · NPPES record last updated Apr 21, 2025

Key facts

NPI
1649547944
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
SAC HEALTH SYSTEM
Practice address
488 S K St
San Bernardino, CA 92410-2641
Phone
(909) 382-7100
Fax
(909) 386-7910
NPI assigned
Nov 30, 2011
Organization subpart
No

Authorized official

Name
Tasha Amick
Title
Director of Billing
Phone
(909) 382-7100

Owners & managing parties with NPI records 3

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

Other NPIs on the same Medicare enrollment 9

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

Other NPIs with the same Medicare PAC ID 12

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

Corporate family (same tax ID) 17

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

Practitioners 240

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

View all 240

Medicare participation

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

Federally qualified health center certification: CCN 551156

Legal name
SAC HEALTH SYSTEM
Doing business as
SAC HEALTH SYSTEM FRAZEE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 29, 2012
Last certification
Jun 29, 2012
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Sep 18, 1995 in CA
Enrollment address
488 S K St
San Bernardino, CA 92410-2641

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Peter J Baker
Individual 		Corporate Director Feb 22, 2022
Angela Teresi
Individual 		W-2 Managing Employee
Credentialing Supervisor		 Jun 29, 2015
Jason Lohr
Individual 		Corporate Officer
Ceo		 Dec 1, 2018
Bonnie I CHI Lum
Individual 		Corporate Officer
Cmo		 Jul 1, 2018
Pat Morris
Individual 		Corporate Director Sep 24, 2019
Raul Castillo
Individual 		Corporate Director
Board Member		 Jan 1, 2000
Richard Henry Hart
Individual 		Corporate Officer
Board Member		 Jul 1, 2011
Edith Ann Atkinson
Individual 		Corporate Director
Board Member		 Jul 1, 2011
Jordan Urban
Individual 		Corporate Officer
Cfo		 Dec 30, 2022
Maryellen R Westerberg
Individual 		Corporate Officer Jul 1, 2018
Rodney Neal
Individual 		Corporate Officer
Board Member		 Jul 1, 2011
Jessica Garcia
Individual 		Corporate Director Feb 22, 2022
Marilyn Hermann
Individual 		Corporate Director
Board Member		 Jul 1, 2011
Ken Ramirez
Individual 		Corporate Director Jan 26, 2021

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040315000608 CA Part B Supplier - Clinic/Group Practice 4385533579 Receives reassigned benefits from 461 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indio, CA; Murrieta, CA; Rialto, CA; San Bernardino, CA
O20120629000147 CA Part a Provider - Federally Qualified Health Center (FQHC) 4385533579 1 other NPI on this enrollment
Practice locations: San Bernardino, CA

National Provider Directory

Tax ID family
Sac Health System Norto (18 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X CMM70744F CA
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

488 S K St
San Bernardino, CA 92410-2641

Mailing address

488 S K St
San Bernardino, CA 92410-2641
Phone (909) 383-8092

Other identifiers

IdentifierTypeStateIssuer
CMM70744FMedicaidCA

Other providers in San Bernardino, CA

All providers in San Bernardino, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.