NPIMap

Organization Active NPI

Elica Health Centers

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1740660703
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ELICA HEALTH CENTERS
Practice address
1750 Wright St Ste 1
Sacramento, CA 95825-4041
Phone
(916) 454-2345
Fax
(916) 890-3828
NPI assigned
Jun 4, 2015
Last updated
Mar 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Authorized official

Name
Tatyana Bak
Title
Ceo
Phone
(916) 569-8484

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X CA Primary
Case Manager/Care Coordinator 171M00000X

Addresses

Primary practice location

1750 Wright St Ste 1
Sacramento, CA 95825-4041

Mailing address

1860 Howe Ave Ste 440
Sacramento, CA 95825-1098
Phone (916) 569-8484

Other identifiers 1

IdentifierTypeStateIssuer
CB101AOtherCAMEDICARE PART B

Other names 1

  • Elica Health Centers- Arden Arcade Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090818000598 CA Part B Supplier - Clinic/Group Practice 4385706845 Receives reassigned benefits from 105 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; West Sacramento, CA; North Highlands, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740660703. Details of each certification follow.

  • CCN 751197 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 751197

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
ELICA HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 22, 2015
Last certification
Jul 22, 2015
Ownership / control type
For profit – corporation
Facility address
1750 Wright Street, Suite 1
Sacramento, CA 95825

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1740660703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 HOWE AVE STE 440",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958251098",
            "telephone_number": "916-569-8484",
            "fax_number": "916-256-2214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 WRIGHT ST STE 1",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958254041",
            "telephone_number": "916-454-2345",
            "fax_number": "916-890-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELICA HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "BAK",
        "authorized_official_first_name": "TATYANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-569-8484"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "CB101A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elica Health Centers- Arden Arcade",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.