NPIMap

Organization Active NPI

Ole Health

  • Federally Qualified Health Center (FQHC)
  • West Sacramento, CA
National Provider Identifier
1710087515
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
030000771 Issued in CA
Legal business name
OLE HEALTH
Practice address
500 B Jefferson Blvd
#180
West Sacramento, CA 95605
Phone
(916) 375-6400
Fax
(916) 375-6413
NPI assigned
Sep 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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)CodeLicenseStatePrimary
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 identifiers 2

IdentifierTypeStateIssuer
FHC70983FMedicaidCA
ZZZ26460ZMedicaidCA

Other names 1

  • CommuniCare OLE Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

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
CorporationNon-profit
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).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Ole Health22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

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.

NameRoleSinceShare
Wetona S Eidson-Ton Individual Corporate OfficerChief Medical Officer Oct 1, 2023
W-2 Managing EmployeeChief Medical Officer Oct 1, 2023
Peter Richmond Individual Corporate DirectorVice Board Chair Jul 1, 2017
Madeline Hernandez Individual Corporate DirectorBoard Member Dec 1, 2018
Randall Cooksey Individual Corporate DirectorBoard Member Jan 1, 2020
Deborah Goodin Individual Corporate DirectorBoard Member Jun 1, 2021
Ridge Tolbert Individual Corporate DirectorBoard Member Jan 1, 2018
Beatriz I Cabezon Individual Corporate DirectorBoard Member Jan 1, 2004
Michael D Golde Individual Corporate DirectorBoard Chair Jul 1, 2010
Zeenat Tariq Individual Corporate DirectorBoard Member Jan 1, 2021
Iliana Chevez Individual Corporate DirectorBoard Secretary Jan 1, 2017
Exa Johanna Moore Individual Corporate DirectorBoard Member Sep 1, 2003
Beatrice Labastida Individual Corporate DirectorBoard Member Dec 1, 2013
Rose M Conroy Individual Corporate DirectorBoard Member Jan 1, 2010
Arthur Roosa Individual Corporate DirectorBoard Chair Jun 1, 2019
Patricia McFarland Individual Corporate DirectorBoard Member Jan 1, 2017
Monin Martin Individual Corporate DirectorBoard Member Oct 1, 2019
Lynn Bramwell Individual Corporate OfficerChief Administrative and Operati Oct 1, 2023
Cephas Mugerwa Individual Corporate DirectorBoard Member Jun 1, 2021
Bryan Nazario Individual Corporate DirectorBoard Member Aug 24, 2021
Frederick D Baker Individual Corporate DirectorBoard Member Jan 1, 2012
Lori Wilson Individual Corporate DirectorBoard Member Jun 1, 2021
Anna Roth Individual Corporate DirectorBoard Member Oct 1, 2019
Rosemarie Bautista Macisaac Individual Corporate OfficerChief Financial Officer Jun 5, 2023
Alicia F Hardy Individual Corporate OfficerChief Executive Officer Jan 6, 2018
W-2 Managing EmployeeChief Executive Officer 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.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ole HealthFairfield, CA, CCN 921815 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.

  • Ole Health
    • Federally Qualified Health Center (FQHC)
    • Fairfield, CA
    • NPI 1316429558

    Operational/Managerial Control

    CMS ownership

Change-of-ownership history 2

DateEventCounterparty
Oct 1, 2023 Change of OwnershipThis provider was the buyer Salud ClinicCCN 051005, CA, NPI 1710087515
Oct 1, 2023 Change of OwnershipThis provider was the seller Salud ClinicCCN 051005, CA, NPI 1710087515

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 56

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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70983F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ26460Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CommuniCare OLE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Sacramento, CA

Sources for this page

Verify at the official NPI Registry.