NPIMap

Organization Active NPI

Sac Health System

Doing business as Sac San Bernardino Campus

  • Federally Qualified Health Center (FQHC)
  • San Bernardino, CA
National Provider Identifier
1801270137
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAC HEALTH SYSTEM
Doing business as
Sac San Bernardino Campus
Practice address
250 South G Street
San Bernardino, CA 92410
Phone
(909) 382-7100
NPI assigned
Jul 16, 2015
Last updated
Aug 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

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

Authorized official

Name
Tasha Amick
Title
Dir of Billing
Phone
(909) 382-7100

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X CMM70708F CA
Dental Clinic/Center 261QD0000X G91341 CA
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X CMM70708F CA

Addresses

Primary practice location

250 South G Street
San Bernardino, CA 92410

Mailing address

1003 E Brier Dr
San Bernardino, CA 92408-2862
Phone (909) 382-7100

Other identifiers 3

IdentifierTypeStateIssuer
ENVOY3000OtherCAENVOY SITE ID
EAP70708FOtherCAEAPC
CMM70708FMedicaidCA

Other names 1

  • SAC SAN BERNARDINO CAMPUS Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040315000608 CA Part B Supplier - Clinic/Group Practice 4385533579 Receives reassigned benefits from 461 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Indio, CA; Murrieta, CA; Rialto, CA; San Bernardino, CA
O20161101001246 CA Part A Provider - Federally Qualified Health Center (FQHC) 4385533579 Practice locations: San Bernardino, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801270137. Details of each certification follow.

Federally qualified health center certification: CCN 751969

Legal name
SAC HEALTH SYSTEM
Doing business as
SAC HEALTH SYSTEM SAN BERNARDINO CAMPUS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 19, 2016
Last certification
Sep 19, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 5, 1995 in CA
Enrollment address
250 S G St
San Bernardino, CA 92410-3320

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

Locations

1455 3rd Ave
Sn Bernrdno, CA 92408
Phone (909) 382-7146

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Angela Teresi Individual W-2 Managing Employee Jun 29, 2015
Jason Lohr Individual Corporate OfficerInterim Ceo Jul 1, 2016
Raul Castillo Individual Corporate DirectorBoard Member Apr 1, 2014
Richard Henry Hart Individual Corporate DirectorBoard Member Jul 1, 2014
Edith Ann Atkinson Individual Corporate DirectorBoard Member Mar 1, 2010
Rodney Neal Individual Corporate DirectorBoard Member Sep 1, 2014
Marilyn Hermann Individual Corporate DirectorBoard Member Mar 1, 2010

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 125

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 125

NPI Registry JSON

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786406400000",
    "number": "1801270137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 E BRIER DR",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082862",
            "telephone_number": "909-382-7100",
            "fax_number": "909-382-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 SOUTH G STREET",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "92410",
            "telephone_number": "909-382-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAC HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A",
        "authorized_official_last_name": "AMICK",
        "authorized_official_first_name": "TASHA",
        "authorized_official_title_or_position": "DIR OF BILLING",
        "authorized_official_telephone_number": "909-382-7100"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "CMM70708F",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "G91341",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CA",
            "license": "CMM70708F",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ENVOY SITE ID",
            "identifier": "ENVOY3000",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP70708F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70708F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SAC SAN BERNARDINO CAMPUS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SAC SAN BERNARDINO CAMPUS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.