NPIMap

Organization Active NPI

Ampla Health

  • Federally Qualified Health Center (FQHC)
  • Los Molinos, CA
National Provider Identifier
1811329899
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
AMPLA HEALTH
Practice address
7981 Highway 99E
Los Molinos, CA 96055-9782
Phone
(530) 384-4010
Fax
(530) 384-4016
NPI assigned
Aug 1, 2013
Last updated
Feb 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Benjamin H Flores, MPH
Title
President & Chief Executive Officer
Phone
(530) 751-3778

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X CA Primary
Case Manager/Care Coordinator 171M00000X

Addresses

Primary practice location

7981 Highway 99E
Los Molinos, CA 96055-9782

Mailing address

PO Box Ad
Yuba City, CA 95992-1396
Phone (530) 751-3778

Other identifiers 1

IdentifierTypeStateIssuer
1811329899MedicaidCA

Other names 1

  • Ampla Health Los Molinos Medical Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040225001116 CA Part B Supplier - Clinic/Group Practice 5092619270 Receives reassigned benefits from 154 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Yuba City, CA; Chico, CA; Oroville, CA; Orland, CA; Olivehurst, CA; Los Molinos, CA; Hamilton City, CA; Gridley, CA…
O20140916001828 CA Part A Provider - Federally Qualified Health Center (FQHC) 5092619270 Practice locations: Los Molinos, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811329899. Details of each certification follow.

Federally qualified health center certification: CCN 751122

Legal name
AMPLA HEALTH
Doing business as
AMPLA HEALTH LOS MOLINOS MEDICAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 18, 2014
Last certification
Sep 18, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1973 in CA
Enrollment address
7981 Highway 99 E
Los Molinos, CA 96055

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 13

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

View all 13

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kim D Owens Individual Corporate DirectorBoard Member Jul 21, 2014
Benjamin H Flores Individual Corporate OfficerPresident and Ceo Apr 1, 2009 100%
J Angel Calderon Individual Corporate DirectorBoard Member Jul 21, 2014
Ernest Garcia Individual Corporate DirectorBoard Member Apr 1, 2015
Lorenzo Valdovinos Individual Corporate DirectorBoard Member Oct 23, 2018
Carlos Palacios Individual Corporate DirectorBoard Member May 1, 2017
Roberto B Gonzalez Individual Corporate DirectorBoard Member Jul 21, 2014
Mark a Lundberg Individual Corporate DirectorBoard Member Apr 1, 2017
Teng Vang Individual Corporate DirectorBoard Member Jun 25, 2019
Horacio Paras Individual Corporate DirectorBoard Member Jul 21, 2014
Joyce Pope Individual Corporate DirectorBoard Member Feb 1, 2020
Vicki L Chissie Individual W-2 Managing EmployeeBilling Manager Jul 21, 2014 1%
Debbie D Porcayo Individual Corporate DirectorBoard Member Jul 21, 2014
Lilia Childs Individual Corporate DirectorBoard Member Mar 1, 2015
Wenceslao Vasquez Individual Corporate DirectorBoard Member Jul 21, 2014

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 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1375315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1811329899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX AD",
            "city": "YUBA CITY",
            "state": "CA",
            "postal_code": "959921396",
            "telephone_number": "530-751-3778",
            "fax_number": "530-751-1237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7981 HIGHWAY 99E",
            "city": "LOS MOLINOS",
            "state": "CA",
            "postal_code": "960559782",
            "telephone_number": "530-384-4010",
            "fax_number": "530-384-4016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMPLA HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-01",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "530-751-3778",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811329899",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ampla Health Los Molinos Medical",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Ampla Health Los Molinos Medical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Molinos, CA

Sources for this page

Verify at the official NPI Registry.