St. Jude Neighborhood Health Centers

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

ST. JUDE NEIGHBORHOOD HEALTH CENTERS

Practice address

17071 Main St Ste 100
Hesperia, CA 92345-6071

Phone

(760) 956-7714

NPI assigned

Mar 9, 2020

Organization subpart

No

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

Authorized official

Name

Timothy Jason Brown

Title

Chief Executive Officer

Phone

(208) 899-9631

Specialties & licenses 1

Addresses

Other names 1

• St. Mary Health Centers- Hesperia Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851926000. Details of each certification follow.

• CCN A01058 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN A01058

Legal name

ST. MARY HEALTH CENTERS - HESPERIA

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 21, 2022

Last certification

Feb 21, 2022

Ownership / control type

For profit – corporation

Facility address

17071 Main St, Ste 100
Hesperia, CA 92345

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• St. Jude Neighborhood Health Centers

  • Primary Care Clinic/Center
  • Fullerton, CA
  • NPI 1316206592

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596499200000",
    "number": "1851926000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17071 MAIN ST STE 100",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923456071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17071 MAIN ST STE 100",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923456071",
            "telephone_number": "760-956-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JUDE NEIGHBORHOOD HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2020-08-04",
        "certification_date": "2020-08-04",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "208-899-9631"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary Health Centers- Hesperia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Alphonso Lancelot Spears III
• Milbrycleyo Spicer
• Spring Valley Lake Pharmacy Inc (A Family Pharmacy)
• Albert Lamont Springer
• Stevie Alicia St Onge
• St. Mary High Desert Home Health Services, LLC (Providence Home Health High Desert)
• Annabelle Mae Stelling
• Brooke Nichole Stewart-Hardin, M.A.
• Kathryn E Stewart, PA-C
• Madison Stewart

• Primary Care Clinic/Center in Hesperia, CA
• Providers in Hesperia, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.