NPIMap

Organization Active NPI

Community Medical Centers, Inc

Doing business as dixon family practice

  • Federally Qualified Health Center (FQHC)
  • Dixon, CA
National Provider Identifier
1699766519
Registry record updated May 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
010000152 Issued in CA
Legal business name
COMMUNITY MEDICAL CENTERS, INC
Doing business as
dixon family practice
Practice address
131 W a St Ste 1
Dixon Family Practice
Dixon, CA 95620-3437
Phone
(707) 635-1600
Fax
(707) 635-1641
NPI assigned
Oct 31, 2005
Last updated
May 21, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2015

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

Authorized official

Name
Mrs. Christine C Noguera
Title
Ceo
Phone
(209) 373-2831

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 010000152 CA Primary

Addresses

Primary practice location

131 W a St Ste 1
Dixon Family Practice
Dixon, CA 95620-3437

Mailing address

7210 Murray Dr
PO Box 779
Stockton, CA 95210-3339
Phone (209) 373-2800

Other identifiers 1

IdentifierTypeStateIssuer
FHC03864FMedicaidCA

Other names 1

  • dixon family practice Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080909000472 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426968520 Practice locations: Dixon, CA
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699766519. Details of each certification follow.

Federally qualified health center certification: CCN 051830

Legal name
COMMUNITY MEDICAL CENTERS, INC.
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
CorporationNon-profit
Incorporated
Jan 9, 1978 in CA
Enrollment address
131 W a St
Ste 1
Dixon, CA 95620-3437

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

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 DirectorBoard Member Jul 1, 1989
Robert Smith Individual Corporate DirectorBoard Member Jul 1, 2013
Pamela Maffei Individual Corporate DirectorBoard Member Jul 1, 2011
Dora Vivero Individual W-2 Managing EmployeeDirector of Revenue Cycle May 9, 2015
Christine C Noguera Individual Corporate OfficerCeo Jul 2, 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 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432166400000",
    "number": "1699766519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7210 MURRAY DR",
            "address_2": "PO BOX 779",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952103339",
            "telephone_number": "209-373-2800",
            "fax_number": "209-373-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 W A ST STE 1",
            "address_2": "DIXON FAMILY PRACTICE",
            "city": "DIXON",
            "state": "CA",
            "postal_code": "956203437",
            "telephone_number": "707-635-1600",
            "fax_number": "707-635-1641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2015-05-21",
        "status": "A",
        "authorized_official_last_name": "NOGUERA",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-373-2831",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "010000152",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03864F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dixon family practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dixon, CA

Sources for this page

Verify at the official NPI Registry.