NPIMap

Organization Active NPI

Santa Rosa Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
National Provider Identifier
1780195255
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SANTA ROSA COMMUNITY HEALTH CENTERS
Practice address
1300 N Dutton Ave
Santa Rosa, CA 95401-7112
Phone
(707) 303-3600
NPI assigned
Oct 23, 2017
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
SANTA ROSA COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Authorized official

Name
Gabriela Bernal-Leroi, CEO
Title
Director of Revenue Cycle
Phone
(707) 303-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1300 N Dutton Ave
Santa Rosa, CA 95401-7112

Mailing address

3569 Round Barn Cir
Santa Rosa, CA 95403-5781
Phone (707) 303-3600

Other names 1

  • Dutton Campus Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040319001444 CA Part B Supplier - Clinic/Group Practice 0345130423 Receives reassigned benefits from 204 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Rosa, CA
O20180411002373 CA Part A Provider - Federally Qualified Health Center (FQHC) 0345130423 Practice locations: Santa Rosa, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780195255. Details of each certification follow.

Federally qualified health center certification: CCN 921053

Legal name
SANTA ROSA COMMUNITY HEALTH CENTERS
Doing business as
DUTTON CAMPUS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 3, 2018
Last certification
May 3, 2018
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jun 14, 1994 in CA
Enrollment address
1300 N Dutton Ave
Santa Rosa, CA 95401-7112

Other NPIs with the same Medicare PAC ID 4

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
Tax ID family
Santa Rosa Community Health16 organizations share this tax ID, including this one
Part of
Santa Rosa Community Health

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Santa Rosa Community Health Centers Organization, Santa Rosa, CA Non-profit Operational/Managerial Control Apr 2, 2018 100%
Gabriela Bernal Leroi Individual Corporate OfficerCeo Jul 1, 2022
W-2 Managing EmployeeCeo Jul 1, 2022
Operational/Managerial ControlCeo Jul 1, 2022
James Eimers Individual Corporate DirectorBoard Member Jul 1, 2012
Karla Garcia Lugo Individual Corporate DirectorBoard Member Jul 1, 2013
Robert Benavides Individual Corporate DirectorBoard Member Nov 1, 2019
Margery Kathleen Galvin Individual Corporate DirectorBoard Member Mar 1, 2019
John Sawyer Individual Corporate DirectorBoard Member Nov 1, 2013
Anita Maldonado Individual Corporate DirectorBoard Member Jul 1, 2020
William Snow Individual Corporate DirectorChair Jul 1, 2017
Maria de Jesus Dalia Villagomez Pulido Individual Corporate DirectorBoard Member Aug 1, 2015
Francisco J Cano Adeath Individual Corporate DirectorBoard Member Nov 1, 2016

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1780195255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3569 ROUND BARN CIR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954035781",
            "telephone_number": "707-303-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 N DUTTON AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954017112",
            "telephone_number": "707-303-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SANTA ROSA COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2017-10-23",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "BERNAL-LEROI",
        "authorized_official_first_name": "GABRIELA",
        "authorized_official_title_or_position": "DIRECTOR OF REVENUE CYCLE",
        "authorized_official_telephone_number": "707-303-3600",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dutton Campus",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.