NPIMap

Organization Active NPI

Community Medical Centers, Inc.

  • Clinic/Center
  • Stockton, CA
National Provider Identifier
1669720157
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
1200109024 Issued in CA
Legal business name
COMMUNITY MEDICAL CENTERS, INC.
Practice address
2015 S Mariposa Rd
Stockton, CA 95205-7735
Phone
(209) 373-2800
NPI assigned
Aug 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Authorized official

Name
Mr. Arthur Feagles Jr.
Title
Cfo
Phone
(209) 373-2803

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 1200109024 CA Primary

Addresses

Primary practice location

2015 S Mariposa Rd
Stockton, CA 95205-7735

Mailing address

7210 Murray Dr
Stockton, CA 95210-3339

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101027000870 CA Part B Supplier - Clinic/Group Practice 8426968520 Receives reassigned benefits from 171 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vacaville, CA; Tracy, CA; Stockton, CA; Manteca, CA; Lodi, CA; Esparto, CA; Dixon, CA
O20130821001062 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426968520 Practice locations: Stockton, CA

Federally qualified health center certification: CCN 751019

Legal name
COMMUNITY MEDICAL CENTERS, INC.
Doing business as
COMMUNITY MEDICAL CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 21, 2013
Last certification
Aug 21, 2013
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 9, 1978 in CA
Enrollment address
2015 S Mariposa Rd
Stockton, CA 95205-7735

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
CMC Inc Dixon Family PR65 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

Locations

1801 E March Ln
Ste D470
Stockton, CA 95210
Phone (209) 507-7000

2640 E Lafayette St
Stockton, CA 95205
Phone (209) 751-5221

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Ruby V King Individual Corporate DirectorBoard Member Jul 1, 2018
Jaime DG Allen Individual Corporate OfficerCfo Jan 1, 2019
Lily Aman Individual Corporate OfficerBoard Member Jun 21, 1989
Robert Smith Individual Corporate DirectorBoard Member Jul 1, 2013
Pamela Maffei Individual Corporate DirectorBoard Member Jul 1, 2012
Dora Vivero Individual W-2 Managing EmployeeManaging Employee Jan 1, 2021
Christine C Noguera Individual Corporate OfficerCeo Jul 1, 2014
Jasmine Leek Individual Corporate DirectorBoard Member Jul 1, 2015
Martha Robles Individual Corporate DirectorBoard Member Jul 1, 2019
Roger Speed Individual Corporate DirectorBoard Member Jul 1, 2004
Peter W Ragsdale Individual Corporate DirectorBoard Member Jul 1, 2018
Martha Dukes Individual Corporate DirectorBoard Member Jul 1, 1985

Practitioners & affiliated clinicians

Practitioners 56

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

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1344988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1669720157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210 MURRAY DR",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 S MARIPOSA RD",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952057735",
            "telephone_number": "209-373-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-15",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "FEAGLES",
        "authorized_official_first_name": "ARTHUR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "209-373-2803",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "1200109024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.