NPIMap

Organization Active NPI

Healthright 360

Doing business as Haight Ashbury Free Clinic

  • Federally Qualified Health Center (FQHC)
  • San Francisco, CA
National Provider Identifier
1760427843
Registry record updated Mar 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HEALTHRIGHT 360
Doing business as
Haight Ashbury Free Clinic
Practice address
558 Clayton St
San Francisco, CA 94117-2907
Phone
(415) 226-1775
NPI assigned
Jun 20, 2006
Last updated
Mar 1, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2019

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

Authorized official

Name
Ms. Vitka Eisen, MSW, ED.D
Title
President & Ceo
Phone
(415) 762-3700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Primary Care Clinic/Center 261QP2300X 220000030 CA

Addresses

Primary practice location

558 Clayton St
San Francisco, CA 94117-2907

Mailing address

1563 Mission Street, 4TH Floor
San Francisco, CA 94103-2543
Phone (415) 762-3700

Other identifiers 1

IdentifierTypeStateIssuer
11599FMedicaidCA

Other names 1

  • Haight Ashbury Free Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070730000160 CA Part B Supplier - Clinic/Group Practice 3678674025 Receives reassigned benefits from 85 practitioners
8 other NPIs on this enrollment
Practice locations: San Francisco, CA; San Mateo, CA; San Jose, CA; Pomona, CA; Pasadena, CA
O20120106000552 CA Part A Provider - Federally Qualified Health Center (FQHC) 3678674025 Practice locations: San Francisco, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760427843. Details of each certification follow.

Federally qualified health center certification: CCN 551111

Legal name
HEALTHRIGHT 360
Doing business as
HAIGHT ASHBURY FREE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 2012
Last certification
Jan 6, 2012
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Mar 18, 1966 in CA
Enrollment address
558 Clayton St
San Francisco, CA 94117-2907

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christopher Gurley Individual Corporate Director Jan 1, 2020
Ahmad Thomas Individual Corporate Director Jan 1, 2020
Diane Ireland Individual Corporate Director Jan 1, 2019
Bryan Graham Individual Corporate Director Jan 1, 2016
Karen Pointer Individual Corporate Director Jan 1, 2016
Natalie Mitchell Individual Corporate Director Jan 1, 2019
Vitka Eisen Individual 5% Or Greater Indirect Ownership InterestCeo Jul 31, 2016
Corporate OfficerCeo Jan 5, 2011
Operational/Managerial Control Jan 5, 2011
Kathryn W Holmes Individual Corporate Director Jan 1, 2019
Linda Smart Individual Corporate Director Jan 1, 2022
Yener a Balan Individual Corporate Director Jan 1, 2018
Daniel Binder Individual Corporate Director Jan 1, 2019
Tony Duong Individual Corporate OfficerCfo Apr 1, 2017
W-2 Managing EmployeeCfo Apr 10, 2017
Alex Pugh Individual Corporate Director Jan 1, 2018
Timothy Torres Individual Corporate Director Jan 1, 2019

Practitioners & affiliated clinicians

Practitioners 93

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 93

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551398400000",
    "number": "1760427843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1563 MISSION STREET, 4TH FLOOR",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941032543",
            "telephone_number": "415-762-3700",
            "fax_number": "415-865-0119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "558 CLAYTON ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941172907",
            "telephone_number": "415-226-1775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHRIGHT 360",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2019-03-01",
        "status": "A",
        "authorized_official_last_name": "EISEN",
        "authorized_official_first_name": "VITKA",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "415-762-3700",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSW, ED.D"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "220000030",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11599F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Haight Ashbury Free Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Haight Ashbury Free Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.