NPIMap

Organization Active NPI

Gardner Family Health Network Inc

Doing business as St James Health Center

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1700915097
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
FHC70262F Issued in CA
Legal business name
GARDNER FAMILY HEALTH NETWORK INC
Doing business as
St James Health Center
Practice address
55 E Julian St
San Jose, CA 95112-4007
Phone
(408) 935-3933
Fax
(408) 935-3988
NPI assigned
Mar 5, 2007
Last updated
May 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2023

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

Authorized official

Name
Ofelia Ruiz
Title
Director
Phone
(408) 935-3971

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X FHC70262F CA Primary
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

55 E Julian St
San Jose, CA 95112-4007

Mailing address

PO Box 1240
Alviso, CA 95002-1240
Phone (408) 935-3933

Other identifiers 4

IdentifierTypeStateIssuer
FHC70014FMedicaidCA
HAP70014FOtherCASOFPSTJ
BCP70014FOtherCABCEDPSTJ
EAP70014FOtherCAEAPCSTJ

Other names 1

  • ST JAMES 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
O20130517000268 CA Part A Provider - Federally Qualified Health Center (FQHC) 5890859375 Practice locations: San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700915097. Details of each certification follow.

Federally qualified health center certification: CCN 551860

Legal name
GARDNER FAMILY HEALTH NETWORK INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 1998
Last certification
Jul 1, 1998
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1974 in CA
Enrollment address
55 E Julian Street
San Jose, CA 95112-4007

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Family Health Fndtn Alv33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Irma M Terrazas Individual Corporate DirectorBoard Member Sep 19, 2000
Joann Zimmerman Individual Corporate DirectorBoard Member Oct 1, 2015
Allison L Escho Individual Corporate DirectorBoard Member Jan 1, 2017
Adolfo Gomez Porras Individual Corporate DirectorBoard Member Dec 14, 1971
Reymundo C Espinoza Individual Corporate DirectorCeo Jul 1, 1997
W-2 Managing Employee Jun 5, 2013
Guillermo Viveros Individual Corporate DirectorBoard Member Dec 1, 2017
William Roth Individual Corporate DirectorBoard Member Mar 1, 2015
Noe Pablo Lozano Individual Corporate DirectorBoard Member Jul 1, 1997
Efrain Coria Individual Corporate OfficerChief Operating Officer Jul 1, 1997
Frank V Serrano Individual Corporate DirectorBoard Member Jun 15, 2004
Patricia Gutierrez Individual Corporate DirectorBoard Member Jan 1, 2015

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1700915097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1240",
            "city": "ALVISO",
            "state": "CA",
            "postal_code": "950021240",
            "telephone_number": "408-935-3933",
            "fax_number": "408-935-3988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 E JULIAN ST",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951124007",
            "telephone_number": "408-935-3933",
            "fax_number": "408-935-3988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDNER FAMILY HEALTH NETWORK INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "RUIZ",
        "authorized_official_first_name": "OFELIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "408-935-3971"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "FHC70262F",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70014F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOFPSTJ",
            "identifier": "HAP70014F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCEDPSTJ",
            "identifier": "BCP70014F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPCSTJ",
            "identifier": "EAP70014F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST JAMES HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ST JAMES HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.