NPIMap

Organization Active NPI

Santa Rosa Community Health Centers

Doing business as Elsie Allen Campus

  • Federally Qualified Health Center (FQHC)
  • Santa Rosa, CA
National Provider Identifier
1871651273
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
110000489 Issued in CA
Legal business name
SANTA ROSA COMMUNITY HEALTH CENTERS
Doing business as
Elsie Allen Campus
Practice address
599 Bellevue Ave
Santa Rosa, CA 95407-7713
Phone
(707) 528-5770
Fax
(707) 528-5770
NPI assigned
Dec 5, 2006
Last updated
Dec 9, 2022By the provider in NPPES
Organization subpart
No

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
Chief Executive Officer
Phone
(707) 303-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 110000489 CA Primary

Addresses

Primary practice location

599 Bellevue Ave
Santa Rosa, CA 95407-7713

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
FHC70937FMedicaidCA

Other names 2

  • Elsie Allen Campus Doing business as
  • Southwest Community Health Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

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

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 Healt Centers16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1871651273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3569 ROUND BARN CIRCLE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954035781",
            "telephone_number": "707-303-3600",
            "fax_number": "707-303-3635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "599 BELLEVUE AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954077713",
            "telephone_number": "707-528-5770",
            "fax_number": "707-528-5770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA ROSA COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "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": "CHIEF EXECUTIVE OFFICER",
        "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": "CA",
            "license": "110000489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70937F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elsie Allen Campus",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Southwest Community Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.