NPIMap

Organization Active NPI

Bay Area Community Health

Doing business as McKee Health Clinic

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1679381107
Registry record updated Dec 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BAY AREA COMMUNITY HEALTH
Doing business as
McKee Health Clinic
Practice address
3055 McKee Rd
San Jose, CA 95127-1835
Phone
(510) 252-5882
Fax
(510) 770-8141
NPI assigned
Dec 30, 2024
Last updated
Dec 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2024

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

Authorized official

Name
Trina Monterola
Title
Controller
Phone
(510) 252-6804

Specialties & licenses 1

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

Addresses

Primary practice location

3055 McKee Rd
San Jose, CA 95127-1835

Mailing address

40910 Fremont Blvd
Fremont, CA 94538-4375
Phone (510) 252-6804

Other names 1

  • McKee Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250501000570 CA Part A Provider - Federally Qualified Health Center (FQHC) 1658349824 Practice locations: San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679381107. Details of each certification follow.

Federally qualified health center certification: CCN A01947

Legal name
BAY AREA COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 23, 2025
Last certification
Apr 23, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
3055 McKee Rd
San Jose, CA 95127-1835

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
Tri City Family Plannin32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Ownership & related parties

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
Karen Levine Individual Corporate Director Jun 1, 2020
Marvin L Wong Individual Corporate Director Jun 1, 2020
Carol Thompson Individual Corporate Director Jan 25, 2021
Kobin Lee Individual Corporate Director Jun 1, 2020
Jacqueline B Belser Individual Corporate Director Jun 1, 2020
Sherland D Headley Individual Corporate Director Jun 1, 2020
Carlos John Rosario Individual Corporate Director Jun 1, 2020
Joseph Davalos Individual Corporate Director Jun 1, 2020
Xianzhong Zhu Individual Corporate Director Jun 1, 2020
Brenda L Quillin Individual Corporate Director Jun 1, 2020
Elizabeth Guerrero Individual Corporate Director Jun 1, 2020
Stephanie J Reddell Individual Corporate Director Jun 1, 2020
Ana Robledo Individual Corporate OfficerCorporate Officer Mar 2, 2015
W-2 Managing EmployeeCorporate Officer Mar 2, 2015
Robert J Wyckoff Individual Corporate Director Jun 1, 2020

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Gilroy Health ClinicGilroy, CA, CCN 751868 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Bach Family ClinicSan Jose, CA, CCN 751182 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 1, 2020
Nov 15, 2018
Monterey Plaza Health ClinicSan Jose, CA, CCN 751869 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Mt. Pleasant School Based ClinicSan Jose, CA, CCN 751867 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Bay Area Community Health

    dba Monterey Plaza Health Clinic

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1598387680

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba Mt. Pleasant Health Center

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1659993699

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba Bay Area Community Health Center Of Gilroy

    • Federally Qualified Health Center (FQHC)
    • Gilroy, CA
    • NPI 1871115964

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Bay Area Community Health

    dba BACH Family Clinic

    • Federally Qualified Health Center (FQHC)
    • San Jose, CA
    • NPI 1962024059

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

NPI Registry JSON

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

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1679381107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40910 FREMONT BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945384375",
            "telephone_number": "510-252-6804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3055 MCKEE RD",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951271835",
            "telephone_number": "510-252-5882",
            "fax_number": "510-770-8141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-30",
        "status": "A",
        "authorized_official_last_name": "MONTEROLA",
        "authorized_official_first_name": "TRINA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "510-252-6804"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McKee Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.