NPIMap

Organization Active NPI

Health Service Alliance

Doing business as Hesperia Community Health Center

  • Family Medicine Physician
  • Hesperia, CA
National Provider Identifier
1689492167
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
HEALTH SERVICE ALLIANCE
Doing business as
Hesperia Community Health Center
Practice address
16377 Main St Ste a
Hesperia, CA 92345-3567
Phone
(760) 688-4808
Fax
(760) 688-4816
NPI assigned
Oct 2, 2024
Last updated
Oct 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HEALTH SERVICE ALLIANCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Authorized official

Name
Jeffrey J Cox
Title
Cfo
Phone
(909) 464-9675

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

16377 Main St Ste a
Hesperia, CA 92345-3567

Mailing address

16377 Main St Ste a
Hesperia, CA 92345-3567
Phone (760) 688-4808

Other names 1

  • Hesperia Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040708000369 CA Part B Supplier - Clinic/Group Practice 4587642467 Receives reassigned benefits from 20 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palm Desert, CA; Upland, CA; Rancho Cucamonga, CA; Montclair, CA; Hesperia, CA; Claremont, CA

Other NPIs on the same Medicare enrollment 6

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2339797Hesperia Community Health Center16377 Main St Suite a, Hesperia, CA 92345Certificate of waiverMar 5, 2028

National Provider Directory

National Provider Directory
Tax ID family
Montclair Community Health Center5 organizations share this tax ID, including this one
Part of
Montclair Community Health Center

Other organizations with this tax ID 4

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

Locations

16377 Main St
Ste A
Hesperia, CA 92345
Phone (760) 688-4808

5111 Benito St
Montclair, CA 91763
Phone (909) 399-3173

41990 Cook St
Ste 2002
Palm Desert, CA 92211
Phone (760) 674-7132

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": "1727827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1689492167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16377 MAIN ST STE A",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923453567",
            "telephone_number": "760-688-4808",
            "fax_number": "760-688-4816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16377 MAIN ST STE A",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923453567",
            "telephone_number": "760-688-4808",
            "fax_number": "760-688-4816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH SERVICE ALLIANCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEALTH SERVICE ALLIANCE",
        "enumeration_date": "2024-10-02",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "909-464-9675"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hesperia Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hesperia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.