NPIMap

Organization Active NPI

Wellspace Health

  • Health Service Clinic/Center
  • Sacramento, CA
National Provider Identifier
1740587914
Registry record updated Jul 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
WELLSPACE HEALTH
Practice address
3900 47TH Ave
Sacramento, CA 95824-2430
Phone
(916) 313-8488
Fax
(916) 313-8495
NPI assigned
Feb 23, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2015

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

Authorized official

Name
Dr. Alasdair 'Jonathan' Porteus
Title
Chief Executive Officer
Phone
(916) 737-5555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

3900 47TH Ave
Sacramento, CA 95824-2430

Mailing address

1820 J St
Sacramento, CA 95811-3010
Phone (916) 550-5481

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070623000117 CA Part B Supplier - Clinic/Group Practice 8426157975 Receives reassigned benefits from 123 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Jackson, CA; Citrus Heights, CA; Folsom, CA; North Highlands, CA; Roseville, CA

Federally qualified health center certification: CCN 551095

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WELLSPACE HEALTH AT MARTIN LUTHER KING JR VILLAGES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 22, 2011
Last certification
Jun 22, 2011
Ownership / control type
Non-profit – other
Facility address
3900 47TH Avenue
Sacramento, CA 95824

Other NPIs on the same Medicare enrollment 23

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

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2063286Wellspace Health Martin Luther King Jr Village3900 47TH Ave., Sacramento, CA 95824Certificate of waiverJul 30, 2027

National Provider Directory

National Provider Directory

Locations

777 12th St
Ste 250
Sacramento, CA 95814
Phone (916) 469-4690

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437350400000",
    "number": "1740587914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 J ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958113010",
            "telephone_number": "916-550-5481",
            "fax_number": "916-822-8974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 47TH AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958242430",
            "telephone_number": "916-313-8488",
            "fax_number": "916-313-8495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPACE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-23",
        "last_updated": "2015-07-20",
        "status": "A",
        "authorized_official_last_name": "PORTEUS",
        "authorized_official_first_name": "ALASDAIR",
        "authorized_official_middle_name": "'JONATHAN'",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "916-737-5555",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.