NPIMap

Organization Active NPI

Health and Life Organization, Inc

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1740336734
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTH AND LIFE ORGANIZATION, INC
Practice address
7275 E Southgate Dr
Suite 204
Sacramento, CA 95823-2628
Phone
(916) 428-3788
Fax
(916) 428-0788
NPI assigned
Jan 25, 2007
Last updated
Jan 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

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

Authorized official

Name
Mr. Jerry T. Bliatout, JD
Title
Administrator
Phone
(916) 428-3788

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X A73749 CA
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

7275 E Southgate Dr
Suite 204
Sacramento, CA 95823-2628

Mailing address

3030 Explorer Dr
Sacramento, CA 95827-2728
Phone (916) 642-1867

Other names 1

  • Sacramento Community Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110308000291 CA Part B Supplier - Clinic/Group Practice 1153361886 Receives reassigned benefits from 16 practitioners
4 other NPIs on this enrollment
Practice locations: Sacramento, CA

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2138 Del Paso Blvd
Sacramento, CA 95815
Phone (916) 428-3788

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Sacramento Community Clinic - B. Teri Burns ClinicSacramento, CA, CCN 051958 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 19, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1740336734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 EXPLORER DR",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958272728",
            "telephone_number": "916-642-1867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7275 E SOUTHGATE DR",
            "address_2": "SUITE 204",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958232628",
            "telephone_number": "916-428-3788",
            "fax_number": "916-428-0788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH AND LIFE ORGANIZATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-25",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "BLIATOUT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "916-428-3788",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A73749",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sacramento Community Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Sacramento Community Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.