NPIMap

Organization Active NPI

Wellspace Health

  • Federally Qualified Health Center (FQHC)
  • Roseville, CA
National Provider Identifier
1811262348
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WELLSPACE HEALTH
Practice address
5 Medical Plaza Dr
Suite 170
Roseville, CA 95661-2865
Phone
(916) 978-1738
Fax
(916) 771-3377
NPI assigned
Mar 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Dr. Alasdair Jonathan Porteus, PHD
Title
Chief Executive Officer
Phone
(916) 737-5555

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
ContractorGroup: 193200000X MULTI-SPECIALTY GROUP 171W00000X
Developmentally Disabled Services Day Training Agency 251C00000X
Supports Brokerage Agency 251X00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
Home Delivered Meals 332U00000X
Personal Care AttendantGroup: 193200000X MULTI-SPECIALTY GROUP 3747P1801X
Respite Care 385H00000X

Addresses

Primary practice location

5 Medical Plaza Dr
Suite 170
Roseville, CA 95661-2865

Mailing address

1820 J St
Sacramento, CA 95811-3010
Phone (916) 550-5481

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070623000117 CA Part B Supplier - Clinic/Group Practice 8426157975 Receives reassigned benefits from 123 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Jackson, CA; Citrus Heights, CA; Folsom, CA; North Highlands, CA; Roseville, CA
O20130411000316 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426157975 Practice locations: Roseville, CA

Federally qualified health center certification: CCN 751000

Legal name
WELLSPACE HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 12, 2013
Last certification
Apr 12, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1970 in CA
Enrollment address
5 Medical Plaza Dr 170
Roseville, CA 95661-2867

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 23

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

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2055670Wellspace Health Roseville Community Health Center5 Medical Plaza Dr, Ste 170, Roseville, CA 95661Certificate of waiverMay 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
The Effort Inc Detox42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

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
Brenda a Shipp Individual Corporate OfficerChief Operations Officer Jun 9, 2014
W-2 Managing EmployeeChief Operations Officer Jun 9, 2014
Operational/Managerial ControlChief Operations Officer Jun 9, 2014
Lawrence Maas Individual Corporate DirectorCommunity Director Jul 1, 2006
Chue Vang Individual Corporate OfficerChief Financial Officer Nov 2, 2020
Lisa Stewart Individual Corporate DirectorConsumer Director Jul 1, 2014
Timothy Martin Individual Corporate DirectorSecretary Feb 28, 2017
William Barcellona Individual Corporate DirectorDirector Feb 2, 2022
James Tilton Individual Corporate DirectorBoard President Jul 1, 2004
Jonathan a Porteus Individual Corporate OfficerChief Executive Officer Jan 1, 2011
W-2 Managing EmployeeChief Executive Officer Jan 1, 2011
Operational/Managerial ControlChief Executive Officer Jan 1, 2011
Ruzwa Cooper Individual Corporate DirectorTreasurer Jul 1, 2013
Michael Hunter Individual Corporate DirectorConsumer Director Sep 2, 2019
Leah Murphy Individual Corporate DirectorSecond Vice President Jan 26, 2021
Jo Ann 'Jody' Gray Individual Corporate DirectorConsumer Director Jul 1, 2013
Joyce Whiten Individual Corporate DirectorConsumer Director Apr 27, 2021
Wellspace Health Organization, Sacramento, CA Non-profit Operational/Managerial Control Mar 16, 2012

Owners & managing parties with NPI records 16

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

View all 16

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wellspace HealthSacramento, CA, CCN 051142 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health North Highlands Community Health CenterNorth Highlands, CA, CCN 551020 Federally qualified health center Operational/Managerial Control Nov 27, 2011
Wellspace HealthSacramento, CA, CCN 551021 Federally qualified health center Operational/Managerial Control Jan 4, 2010
Wellspace HealthSacramento, CA, CCN 551022 Federally qualified health center Operational/Managerial Control May 17, 2010
Wellspace Health Healthcare for Women Community Health CenterSacramento, CA, CCN 921070 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921843 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921842 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921841 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sunrise CommunityCitrus Heights, CA, CCN 921844 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sierra Garden 2Roseville, CA, CCN 921840 Federally qualified health center Operational/Managerial Control Feb 7, 1970

Owned or controlled facilities with NPI records 10

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

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1811262348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 J ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958113010",
            "telephone_number": "916-550-5481",
            "fax_number": "916-822-8974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MEDICAL PLAZA DR",
            "address_2": "SUITE 170",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612865",
            "telephone_number": "916-978-1738",
            "fax_number": "916-771-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPACE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "PORTEUS",
        "authorized_official_first_name": "ALASDAIR",
        "authorized_official_middle_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "916-737-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, CA

Sources for this page

Verify at the official NPI Registry.