NPIMap

Organization Active NPI

Indian Health Center of Santa Clara Valley

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
National Provider Identifier
1881997963
Registry record updated Feb 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001783 Issued in CA
Legal business name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Practice address
1642 E Capitol Expy
San Jose, CA 95121-1800
Phone
(408) 445-3400
Fax
(408) 448-1727
NPI assigned
Dec 13, 2010
Last updated
Feb 7, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
INDIAN HEALTH CENTER OF SANTA CLARA VALLEYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 7, 2013

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

Authorized official

Name
Dr. Aldon Wayne Scott, D.M.
Title
Director of Operations
Phone
(408) 445-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550001783 CA Primary

Addresses

Primary practice location

1642 E Capitol Expy
San Jose, CA 95121-1800

Mailing address

1333 Meridian Ave
San Jose, CA 95125-5212
Phone (408) 445-3400

Other names 1

  • Indian Health Center of Santa Clara Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120126000250 CA Part B Supplier - Clinic/Group Practice 1153406665 Receives reassigned benefits from 94 practitioners
5 other NPIs on this enrollment
Practice locations: San Jose, CA
O20120329000770 CA Part A Provider - Federally Qualified Health Center (FQHC) 1153406665 Practice locations: San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881997963. Details of each certification follow.

Federally qualified health center certification: CCN 551120

Legal name
INDIAN HEALTH CENTER OF SANTA CLARA VALLEY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 2, 2012
Last certification
Apr 2, 2012
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Mar 16, 1977 in CA
Enrollment address
1642E Capitol Expy
San Jose, CA 95121-1800

Other NPIs with the same Medicare PAC ID 2

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

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
Indian Health Ctr SC14 organizations share this tax ID, including this one
Part of
Indian Health Ctr SC

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Indian Health Center of Santa Clara Valley Organization, San Jose, CA Operational/Managerial Control Jan 28, 2004
Ira Singh Individual Corporate OfficerChief Operations Officer Aug 17, 2015
W-2 Managing EmployeeChief Operations Officer Aug 17, 2015
Aldon W Scott Individual Corporate OfficerDirector of Operations May 1, 2007
W-2 Managing EmployeeDirector of Operations Jan 17, 2006
Operational/Managerial ControlDirector of Operations Jan 17, 2006
Sonya M Tetnowski Individual Corporate OfficerChief Executive Officer Jun 30, 2014 100%
W-2 Managing EmployeeChief Executive Officer Jun 30, 2014 100%
Pablo D Viramontes Individual Corporate DirectorBoard Member Aug 2, 2005
Paulette T Pico Individual Corporate DirectorBoard of Director Jun 30, 2016
Patrick Brien Individual Corporate DirectorBoard Member Aug 1, 2022
Lisa Aguirre Individual Corporate DirectorSecretary Sep 1, 2019
Soma de Bourbon Individual Corporate DirectorBoard Member Jun 1, 2022
Charlene Eigen-Vasquez Individual Corporate Director Nov 1, 2019
Rene Samayoa Individual Corporate DirectorBoard Member Aug 1, 2022

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Indian Health Center of Santa Clara ValleySan Jose, CA, CCN 751120 Federally qualified health center Operational/Managerial Control Jun 12, 2014

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 96

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 96

NPI Registry JSON

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

{
    "created_epoch": "1292198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360195200000",
    "number": "1881997963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1333 MERIDIAN AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951255212",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1642 E CAPITOL EXPY",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951211800",
            "telephone_number": "408-445-3400",
            "fax_number": "408-448-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDIAN HEALTH CENTER OF SANTA CLARA VALLEY",
        "enumeration_date": "2010-12-13",
        "last_updated": "2013-02-07",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "ALDON",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "408-445-3400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Health Center of Santa Clara",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.