NPIMap

Organization Active NPI

County of Santa Cruz

Doing business as Watsonville Health Center

  • Federally Qualified Health Center (FQHC)
  • Watsonville, CA
National Provider Identifier
1770709149
Registry record updated Nov 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COUNTY OF SANTA CRUZ
Doing business as
Watsonville Health Center
Practice address
1430 Freedom Blvd.
Watsonville, CA 95076
Phone
(831) 763-8400
Fax
(831) 763-8237
NPI assigned
Apr 17, 2007
Last updated
Nov 28, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF SANTA CRUZAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 28, 2023

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

Authorized official

Name
Amy Peeler
Title
Chief of Clinic Services
Phone
(831) 454-4764

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Adult Mental Health Clinic/Center 261QM0850X CA
Adolescent and Children Mental Health Clinic/Center 261QM0855X CA

Addresses

Primary practice location

1430 Freedom Blvd.
Watsonville, CA 95076

Mailing address

1080 Emeline Ave
Santa Cruz, CA 95060-1966
Phone (831) 454-5401

Other identifiers 6

IdentifierTypeStateIssuer
1659315430OtherCALEGAL ENTITY NPI
261QM0850XOtherCATAXONOMY
FHC70044FMedicaidCA
HAP70044FOtherCASTATE OF CA FOR FAMILY PL
BCP70044FOtherCACALIF. CANCER DETECTION
261QM0855XOtherCATAXONOMY

Other names 1

  • Watsonville Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031201000402 CA Part B Supplier - Clinic/Group Practice 7618872912 Receives reassigned benefits from 56 practitioners
3 other NPIs on this enrollment
Practice locations: Santa Cruz, CA; Watsonville, CA
O20080502000340 CA Part B Supplier - Independent Clinical Laboratory 7618872912 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Cruz, CA; Watsonville, CA
O20140630001996 CA Part A Provider - Federally Qualified Health Center (FQHC) 7618872912 Practice locations: Watsonville, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770709149. Details of each certification follow.

Federally qualified health center certification: CCN 751076

Legal name
COUNTY OF SANTA CRUZ
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 30, 2014
Last certification
Jun 30, 2014
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
1430 Freedom Blvd
Watsonville, CA 95076-2780

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Santa Cruz County Health Services Agency

Locations

1080 Emeline Ave
Bldg D
Santa Cruz, CA 95060
Phone 8314544100 ext. 4460

115A Coral St
Santa Cruz, CA 95060
Phone (831) 454-2080

1400 Emeline Ave
Bldg K
Santa Cruz, CA 95060
Phone (831) 454-4900

320 Encinal St
Santa Cruz, CA 95060

12 W Beach St
Watsonville, CA 95076
Phone (831) 763-8955

12 W Beach St
Ste 219
Watsonville, CA 95076
Phone (831) 763-8990

1430 Freedom Blvd
Watsonville, CA 95076
Phone (831) 763-8200

1430 Freedom Blvd
Ste B
Watsonville, CA 95076
Phone (831) 359-5653

1430 Freedom Blvd
Ste D
Watsonville, CA 95076
Phone (831) 763-8400

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Amy Peeler Individual 5% Or Greater Indirect Ownership Interest May 26, 2018
Corporate Director May 26, 2018
W-2 Managing Employee May 26, 2018
County of Santa Cruz Organization, Santa Cruz, CA Operational/Managerial Control May 1, 2014 100%

Owners & managing parties with NPI records 3

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
County of Santa CruzSanta Cruz, CA, CCN 751075 Federally qualified health center Operational/Managerial Control (100%) May 1, 2014

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 180

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 180

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701129600000",
    "number": "1770709149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 EMELINE AVE",
            "city": "SANTA CRUZ",
            "state": "CA",
            "postal_code": "950601966",
            "telephone_number": "831-454-5401",
            "fax_number": "831-454-4488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 FREEDOM BLVD.",
            "city": "WATSONVILLE",
            "state": "CA",
            "postal_code": "95076",
            "telephone_number": "831-763-8400",
            "fax_number": "831-763-8237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SANTA CRUZ",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF SANTA CRUZ",
        "enumeration_date": "2007-04-17",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A",
        "authorized_official_last_name": "PEELER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CHIEF OF CLINIC SERVICES",
        "authorized_official_telephone_number": "831-454-4764"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGAL ENTITY NPI",
            "identifier": "1659315430",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "261QM0850X",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70044F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF CA FOR FAMILY PL",
            "identifier": "HAP70044F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIF. CANCER DETECTION",
            "identifier": "BCP70044F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "261QM0855X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Watsonville Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Watsonville Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watsonville, CA

Sources for this page

Verify at the official NPI Registry.