NPIMap

Organization Active NPI

Southern Indian Health Council

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Boulevard, CA
National Provider Identifier
1902562416
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
SOUTHERN INDIAN HEALTH COUNCIL
Practice address
8 Crestwood Rd
Boulevard, CA 91905-9725
Phone
(619) 445-1188
NPI assigned
Nov 10, 2021
Last updated
Nov 12, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN INDIAN HEALTH COUNCIL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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

Authorized official

Name
Marie Dizon
Title
Lead Biller
Phone
(619) 445-1188

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary

Addresses

Primary practice location

8 Crestwood Rd
Boulevard, CA 91905-9725

Mailing address

8 Crestwood Rd
Boulevard, CA 91905-9725
Phone (619) 445-1188

Other identifiers 2

IdentifierTypeStateIssuer
W7576AOtherCAMEDICARE
THP70010FMedicaidCA

Other names 1

  • SIHC Kumeyaay Wellness Center Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL ALPINE Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180202000177 TX Part B Supplier - Clinic/Group Practice 9830221449 Receives reassigned benefits from 31 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alpine, CA; Boulevard, CA; Campo, CA

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Southern Indian Health5 organizations share this tax ID, including this one
Part of
Southern Indian Health

Other organizations with this tax ID 4

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

Locations

8 Crestwood Rd
Boulevard, CA 91905
Phone (619) 445-1188

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1902562416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 CRESTWOOD RD",
            "city": "BOULEVARD",
            "state": "CA",
            "postal_code": "919059725",
            "telephone_number": "619-445-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 CRESTWOOD RD",
            "city": "BOULEVARD",
            "state": "CA",
            "postal_code": "919059725",
            "telephone_number": "619-445-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INDIAN HEALTH COUNCIL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN INDIAN HEALTH COUNCIL INC",
        "enumeration_date": "2021-11-10",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "DIZON",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "LEAD BILLER",
        "authorized_official_telephone_number": "619-445-1188"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "W7576A",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "THP70010F",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "ALPINE",
            "affiliation": "N",
            "endpointDescription": "SIHC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ALPINE",
            "address_1": "Kumeyaay Wellness Center",
            "address_2": "8 Crestwood Rd",
            "city": "Boulevard",
            "state": "CA",
            "country_code": "US",
            "postal_code": "91905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SIHC Kumeyaay Wellness Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SIHC Kumeyaay Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boulevard, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.