Active NPI
Ole Health
Doing business as CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
National Provider Identifier
1710087515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- License
- 030000771
- Legal business name
- OLE HEALTH
- Doing business as
- CommuniCare OLE
- Practice address
- 500 B Jefferson Blvd
#180
West Sacramento, CA 95605 - Phone
- (916) 375-6400
- Fax
- (916) 375-6413
- NPI assigned
- Sep 22, 2006
- Last updated
- Oct 17, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Rose Macisaac
- Title
- Cfo
- Phone
- (760) 767-6435
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | 030000771 | CA | Primary |
Addresses
Primary practice location
500 B Jefferson Blvd
#180
West Sacramento, CA 95605
Mailing address
PO Box 1260
Davis, CA 95617-1260
Phone (530) 753-3498
Other names 1
- CommuniCare OLE
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161129002365 | CA | Part B Supplier - Clinic/Group Practice | 0345299186 |
Receives reassigned benefits from 67 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: West Sacramento, CA; Woodland, CA; Davis, CA |
| O20240116004191 | CA | Part A Provider - Federally Qualified Health Center (FQHC) | 7315934767 | Practice locations: West Sacramento, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1710087515. Details of each certification follow.
Federally qualified health center certification: CCN 051005
- Legal name
- OLE HEALTH
- Doing business as
- SALUD CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 9, 2005
- Last certification
- Mar 9, 2005
- Ownership / control type
- For profit – partnership
- Most recent change of ownership
- Oct 1, 2023 (1 total)
- Organization structure
- Corporation
- Enrollment address
- 500B Jefferson Boulevard
Ste 180 & 195
West Sacramento, CA 95605-2394
Other NPIs with the same Medicare PAC ID 12
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- Davis, CA
- NPI 1558366823
7315934767
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- Woodland, CA
- NPI 1558469064
7315934767
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
- NPI 1881330579
7315934767
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- Davis, CA
- NPI 1558366823
O20161129002365
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- Woodland, CA
- NPI 1558469064
O20161129002365
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
- NPI 1881330579
O20161129002365
National Provider Directory
National Provider Directory- Tax ID family
- Ole Health
Other organizations with this tax ID 21
Organizations that report the same tax identification number in the National Provider Directory.
-
dba CommuniCare OLE
- Adolescent and Children Mental Health Clinic/Center
- Woodland, CA
- NPI 1073006607
-
dba CommuniCare OLE
- Federally Qualified Health Center (FQHC)
- West Sacramento, CA
- NPI 1144687955
-
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
- NPI 1245043165
-
- Federally Qualified Health Center (FQHC)
- Napa, CA
- NPI 1275257826
-
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
- NPI 1316429558
-
dba CommuniCare Family Wellness Center - Unity Building
- Community/Behavioral Health Agency
- Woodland, CA
- NPI 1366091191
-
- Federally Qualified Health Center (FQHC)
- Napa, CA
- NPI 1447687330
-
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
- NPI 1497130280
-
- Federally Qualified Health Center (FQHC)
- American Canyon, CA
- NPI 1508573379
Locations
500 Jefferson Blvd
#180
West Sacramento, CA 95605
Phone (916) 375-6400
Ownership & related parties
All disclosed owners & managing parties 24
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Wetona S Eidson-Ton | Corporate Officer | Oct 1, 2023 | |
| W-2 Managing Employee | Oct 1, 2023 | ||
| Peter Richmond | Corporate Director | Jul 1, 2017 | |
| Madeline Hernandez | Corporate Director | Dec 1, 2018 | |
| Randall Cooksey | Corporate Director | Jan 1, 2020 | |
| Deborah Goodin | Corporate Director | Jun 1, 2021 | |
| Ridge Tolbert | Corporate Director | Jan 1, 2018 | |
| Beatriz I Cabezon | Corporate Director | Jan 1, 2004 | |
| Michael D Golde | Corporate Director | Jul 1, 2010 | |
| Zeenat Tariq | Corporate Director | Jan 1, 2021 | |
| Iliana Chevez | Corporate Director | Jan 1, 2017 | |
| Exa Johanna Moore | Corporate Director | Sep 1, 2003 | |
| Beatrice Labastida | Corporate Director | Dec 1, 2013 | |
| Rose M Conroy | Corporate Director | Jan 1, 2010 | |
| Arthur Roosa | Corporate Director | Jun 1, 2019 | |
| Patricia McFarland | Corporate Director | Jan 1, 2017 | |
| Monin Martin | Corporate Director | Oct 1, 2019 | |
| Lynn Bramwell | Corporate Officer | Oct 1, 2023 | |
| Cephas Mugerwa | Corporate Director | Jun 1, 2021 | |
| Bryan Nazario | Corporate Director | Aug 24, 2021 | |
| Frederick D Baker | Corporate Director | Jan 1, 2012 | |
| Lori Wilson | Corporate Director | Jun 1, 2021 | |
| Anna Roth | Corporate Director | Oct 1, 2019 | |
| Rosemarie Bautista Macisaac | Corporate Officer | Jun 5, 2023 | |
| Alicia F Hardy | Corporate Officer | Jan 6, 2018 | |
| W-2 Managing Employee | Jan 6, 2018 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Davis, CA
- NPI 1609851674
Corporate Officer, W-2 Managing Employee
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Ole Health | Federally qualified health center | Operational/Managerial Control (100%) | Sep 14, 2018 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Federally Qualified Health Center (FQHC)
- Fairfield, CA
- NPI 1316429558
Operational/Managerial Control
Change-of-ownership history 2
| Date | Event | Counterparty |
|---|---|---|
| Oct 1, 2023 | Change of Ownership | Salud Clinic |
| Oct 1, 2023 | Change of Ownership | Salud Clinic |
Practitioners & affiliated clinicians
Practitioners 47
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.
-
- Pediatrics Physician
- Woodland, CA
- NPI 1588924641
-
- Midwife
- Winters, CA
- NPI 1588036123
-
- Optometrist
- Sacramento, CA
- NPI 1821073461
-
- Internal Medicine Physician
- Davis, CA
- NPI 1386917177
-
- Family Nurse Practitioner
- Piedmont, CA
- NPI 1396141743
-
- Advanced Practice Midwife
- Travis AFB, CA
- NPI 1750751905
Multi-Specialty
-
- Family Nurse Practitioner
- Davis, CA
- NPI 1518631555
-
- Family Nurse Practitioner
- West Sacramento, CA
- NPI 1568190700
Single Specialty
-
- Advanced Practice Midwife
- Davis, CA
- NPI 1679111637
-
- Physician Assistant
- Woodland, CA
- NPI 1922101922
-
- Family Medicine Physician
- West Sacramento, CA
- NPI 1316392657
-
- Advanced Practice Midwife
- Davis, CA
- NPI 1750532305
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1697500800000",
"number": "1710087515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1260",
"city": "DAVIS",
"state": "CA",
"postal_code": "956171260",
"telephone_number": "530-753-3498",
"fax_number": "530-758-2109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 B JEFFERSON BLVD",
"address_2": "#180",
"city": "WEST SACRAMENTO",
"state": "CA",
"postal_code": "95605",
"telephone_number": "916-375-6400",
"fax_number": "916-375-6413"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OLE HEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-22",
"last_updated": "2023-10-17",
"certification_date": "2023-10-17",
"status": "A",
"authorized_official_last_name": "MACISAAC",
"authorized_official_first_name": "ROSE",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "760-767-6435"
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": "CA",
"license": "030000771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CommuniCare OLE",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in West Sacramento, CA
- Occupational Health Centers of California, a Medical Corporation (Concentra Medical Center)
- Oluwaremilekun Loretta Odebiyi
- Tanecia Nicole Offord Nesbitt
- Matthew Kaichi Oki, D.M.D.
- Ole Health (CommuniCare OLE)
- Ole Health (Salud Clinic)
- Ole Health (CommuniCare OLE)
- Ole Health (CommuniCare OLE)
- Katherina Oleynichenko
- Lillian Olson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.