NPIMap

Organization Active NPI

Community Medical Centers, Inc.

Doing business as Woodbridge Medical Group

  • Federally Qualified Health Center (FQHC)
  • Lodi, CA
National Provider Identifier
1881685964
Registry record updated Jul 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
030000424 Issued in CA
Legal business name
COMMUNITY MEDICAL CENTERS, INC.
Doing business as
Woodbridge Medical Group
Practice address
2401 W Turner Rd
Lodi, CA 95242-2182
Phone
(209) 370-1700
Fax
(209) 370-1737
NPI assigned
Oct 28, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2010

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

Authorized official

Name
Mr. Michael H Kirkpatrick
Title
Ceo
Phone
(209) 373-2833

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 030000424 CA Primary

Addresses

Primary practice location

2401 W Turner Rd
Lodi, CA 95242-2182

Mailing address

PO Box 779
Stockton, CA 95201-0779
Phone (209) 373-2800

Other identifiers 1

IdentifierTypeStateIssuer
FHC70460FMedicaidCA

Other names 1

  • Woodbridge Medical Group Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100803000991 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426968520 Practice locations: Lodi, CA
O20101027000870 CA Part B Supplier - Clinic/Group Practice 8426968520 Receives reassigned benefits from 171 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Vacaville, CA; Tracy, CA; Stockton, CA; Manteca, CA; Lodi, CA; Esparto, CA; Dixon, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881685964. Details of each certification follow.

Federally qualified health center certification: CCN 051829

Legal name
COMMUNITY MEDICAL CENTERS, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 9, 1978 in CA
Enrollment address
2401 W Turner Rd
Lodi, CA 95242-2182

Other NPIs with the same Medicare PAC ID 24

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

View all 24

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Woodbridge Medical Grou65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2401 W Turner Rd
Lodi, CA 95242
Phone (209) 370-1700

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Ruby V King Individual Corporate DirectorBoard Member Jul 1, 2018
Jaime DG Allen Individual Corporate OfficerCeo Apr 22, 2019
Lily Aman Individual Corporate DirectorBoard Member Jul 1, 1989
Robert Smith Individual Corporate DirectorBoard Member Jul 1, 2013
Pamela Maffei Individual Corporate DirectorBoard Member Jul 1, 2012
Dora Vivero Individual W-2 Managing EmployeeDirector of Revenue Cycle Feb 1, 2015
Christine C Noguera Individual Corporate OfficerCeo Jul 2, 2014
Jasmine Leek Individual Corporate DirectorBoard Member Jul 1, 2015
Martha Robles Individual Corporate DirectorBoard Member Jul 1, 2019
Roger Speed Individual Corporate DirectorBoard Member Jul 1, 2004
Peter W Ragsdale Individual Corporate DirectorBoard Member Jul 1, 2018
Martha Dukes Individual Corporate DirectorBoard Member Jul 1, 1985

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279065600000",
    "number": "1881685964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 779",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952010779",
            "telephone_number": "209-373-2800",
            "fax_number": "209-373-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W TURNER RD",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952422182",
            "telephone_number": "209-370-1700",
            "fax_number": "209-370-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2010-07-14",
        "status": "A",
        "authorized_official_last_name": "KIRKPATRICK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-373-2833",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "030000424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70460F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodbridge Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lodi, CA

Sources for this page

Verify at the official NPI Registry.