Ampla Health
Organization Active NPI Federally Qualified Health Center (FQHC) · Hamilton City, CA
NPI 1689699415 · NPPES record last updated Feb 29, 2024
Key facts
- NPI
- 1689699415
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 230000196 (CA)
- Legal business name
- AMPLA HEALTH
- Practice address
- 278 Main St.
Hamilton City, CA 95951 - Phone
- (530) 826-3694
- Fax
- (530) 826-3120
- NPI assigned
- Jul 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Benjamin H Flores, MPH
- Title
- President, Chief Executive Officer
- Phone
- (530) 751-3778
Owners & managing parties with NPI records 1
-
Mark Andrew Lundberg, M.D.
Other NPIs on the same Medicare enrollment 13
Other NPIs with the same Medicare PAC ID 16
Corporate family (same tax ID) 12
Practitioners 112
-
Marwa Hammoud, MD
-
Marge Lee, P.A.
-
Huy Q Phung, M.D.
-
Thong Van Truong, DPM
-
Aishwarya Taneja, MBBS
-
Abdullah M Al Dwairi, M.D.
-
Belquis Amani, PA
-
Mustafa Ammar, M.D.
-
Olusola Memud Asafa, PA-C
-
Nasrin Ashouian, MD
-
Prabhjot Aujla, PA-C
-
Jagdeep Singh Bal, M.D.
-
Gary Steven Bernard, D.O
-
Ammar Changezi, MD
-
Bahareh Daneshbod, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 051809
- Legal name
- AMPLA HEALTH
- Doing business as
- AMPLA HEALTH HAMLTON CITY MEDICAL
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 1, 1991
- Last certification
- Oct 1, 1991
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 5, 1973 in CA
- Enrollment address
- 278 Main Street
Hamilton City, CA 95951-0855
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Kim D Owens |
Corporate Director |
Apr 27, 2007 | |
| Benjamin H Flores |
Corporate Officer |
Apr 1, 2009 | 100% |
| J Angel Calderon |
Corporate Director |
Jan 31, 2012 | |
| Lorenzo Valdovinos |
Corporate Director |
Jan 15, 2018 | |
| Roberto B Gonzalez |
Corporate Director |
Jul 30, 2007 | |
| Elizabeth a Skelly |
Corporate Director |
Sep 25, 2012 | |
| Mark a Lundberg |
Corporate Director |
Jan 15, 2018 | |
| Alex T Lu Quin |
Corporate Director |
Jan 28, 2014 | |
| Horacio Paras |
Corporate Director |
Jun 1, 2013 | |
| Vicki L Chissie |
W-2 Managing Employee |
Mar 19, 2012 | |
| Michele L Walters |
Corporate Director |
Sep 25, 2012 | |
| Debbie D Porcayo |
Corporate Director |
Oct 27, 2009 | |
| Wenceslao Vasquez |
Corporate Director |
Jan 28, 2004 | |
| Mary Jane Griego |
Corporate Director |
Jan 15, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040225001116 | CA | Part B Supplier - Clinic/Group Practice | 5092619270 |
Receives reassigned benefits from 154 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Yuba City, CA; Chico, CA; Oroville, CA; Orland, CA; Olivehurst, CA; Los Molinos, CA; Hamilton City, CA; Gridley, CA… |
| O20060201000765 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 5092619270 | Practice locations: Hamilton City, CA |
National Provider Directory
- Tax ID family
- Ampla Health Chico Pharmacy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator |
171M00000X | |||
| Federally Qualified Health Center (FQHC) | 261QF0400X | 230000196 | CA | Yes |
Addresses
Primary practice location
278 Main St.
Hamilton City, CA 95951
Mailing address
PO Box Ad
Yuba City, CA 95992-1396
Phone (530) 751-3778
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BCP80230F | Other | CA | EWC:CDP:BCEDP |
| FHC80230F | Medicaid | CA | |
| HAP80230F | Other | CA | FAMILY PLANNING |
Other names
- AMPLA HEALTH HAMILTON CITY MEDICAL
Other providers in Hamilton City, CA
All providers in Hamilton City, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.