Ole Health
Organization Active NPI Federally Qualified Health Center (FQHC) · Napa, CA
NPI 1700976503 · NPPES record last updated Nov 15, 2019
Key facts
- NPI
- 1700976503
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- 110000098 (CA)
- Legal business name
- OLE HEALTH
- Practice address
- 1141 Pear Tree LN
Napa, CA 94558 - Phone
- (707) 254-1774
- Fax
- (707) 251-2988
- NPI assigned
- Oct 13, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Alicia Hardy
- Title
- Chief Execuitve Officer
- Phone
- (707) 254-1774
Owners & managing parties with NPI records 2
-
Joseph Manuel Carrillo, M.D.
-
Teresa Lynn Shinder, D.O.
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 10
Other NPIs with the same Medicare PAC ID 12
Related certifications (CCN) 2
Practitioners 141
-
Robin A McIntyre, FNP
-
Alfredo Ovalle, M.D.
-
Marikit B Parker, MD
-
Arianna Maria Sousa, LCSW
-
Ariane Heather Watson, LCSW
-
Joy Amanda Moverley, MPH, PA-C
-
Georgina A Samuel, PA-C
-
Linsey Suzanne Aguigam-Leach, FNP-C
-
Angel Aguilera, MD
-
Thomas Clark Andrews, LMFT
-
Mayra Perez Avina, FNP
-
Laura Boyd, M.D.
-
Katiana Leslie Carey-Simms, CNM, WHNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D0601723 | Ole Health (Pear Tree Lane) | Provider-performed microscopy | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 051001
- Legal name
- OLE HEALTH
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 10, 2005
- Last certification
- Jan 10, 2005
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 19, 1972 in CA
- Enrollment address
- 1141 Pear Tree LN
Ste 100
Napa, CA 94558-6485
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Peter Richmond |
Corporate Director | Jul 25, 2017 | |
| Madeline Hernandez |
Corporate Director | Apr 23, 2019 | |
| Dawnielle Thornburgh |
Corporate Director | Jun 15, 2013 | |
| Deborah Goodin |
Corporate Director |
Mar 10, 2022 | |
| Joseph Manuel Carrillo |
Corporate Director | Jul 25, 2017 | |
| Ebon Richard Jones |
Corporate Director | Mar 26, 2013 | |
| Maira Ayala |
Corporate Director | Dec 3, 2013 | |
| Exa Johanna Moore |
Corporate Director | Nov 23, 2004 | |
| Brandy Lane |
Corporate Director |
Mar 10, 2022 | |
| Beatrice Labastida |
Corporate Director | Dec 22, 2015 | |
| Cynthia Macias |
Corporate Director | Oct 14, 2019 | |
| Teresa Lynn Shinder |
Corporate Officer |
Nov 11, 2019 | |
| Arthur Roosa |
Corporate Director | Apr 23, 2019 | |
| Patricia McFarland |
Corporate Director | Dec 6, 2016 | |
| Gary Fedler |
Corporate Officer |
Nov 13, 2017 | |
| Monin Martin |
Corporate Director | Oct 14, 2019 | |
| Cephas Mugerwa |
Corporate Director |
Mar 10, 2022 | |
| Andrew Torge |
Corporate Officer |
Jun 19, 2017 | |
| Bryan Nazario |
Corporate Director |
Mar 10, 2022 | |
| Lori Wilson |
Corporate Director |
Mar 10, 2022 | |
| Anna Roth |
Corporate Director | Oct 14, 2019 | |
| Alicia F Hardy |
Corporate Officer |
Jan 1, 2018 | |
| W-2 Managing Employee |
Jan 1, 2018 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Ole Health |
Federally qualified health center | Operational/Managerial Control (100%) | Sep 14, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040427001735 | CA | Part B Supplier - Clinic/Group Practice | 7315934767 |
Receives reassigned benefits from 134 practitioners 10 other NPIs on this enrollment Practice locations: Napa, CA; Saint Helena, CA; Fairfield, CA; Calistoga, CA; American Canyon, CA |
| O20041118000272 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 7315934767 | Practice locations: Napa, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 110000098 | CA | Yes |
Addresses
Primary practice location
1141 Pear Tree LN
Napa, CA 94558
Mailing address
1141 Pear Tree LN Ste 100
Napa, CA 94558-6485
Phone (707) 254-1770
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| BCP11719F | Other | CA | CDP |
| FHC11719F | Medicaid | CA | |
| HAP11719F | Other | CA | FAMILY PACT |
Other names
- OLE Health
Other providers in Napa, CA
- Robert Laurence Okin
- Ole Health
- Ole Health
- Ole Health
- Ole Health
- Ole Health
- Ole Health
- Ole Health
- Serene Ahwah Oler
- Cuauhtemoc Olguin-Solano
All providers in Napa, 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 Nov 15, 2019. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.