NPIMap

Organization Active NPI

Southern Indian Health Council

  • Health Service Clinic/Center
  • Campo, CA
National Provider Identifier
1922090885
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
SOUTHERN INDIAN HEALTH COUNCIL
Practice address
36350 Church Road
Campo, CA 91906-2715
Phone
(619) 445-1188
Fax
(619) 659-3140
NPI assigned
Aug 17, 2005
Last updated
Nov 12, 2024By the provider in NPPES
Organization subpart
No

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
Terrance A King
Title
Cfo
Phone
(619) 445-1188

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

36350 Church Road
Campo, CA 91906-2715

Mailing address

4058 Willows Road
Alpine, CA 91901-1668
Phone (619) 445-1188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100717000116 CA Part A Provider - Federally Qualified Health Center (FQHC) 9830221449 1 other NPI on this enrollment
Practice locations: Campo, CA
O20180202000177 TX Part B Supplier - Clinic/Group Practice 9830221449 Receives reassigned benefits from 31 practitioners
3 other NPIs on this enrollment
Practice locations: Alpine, CA; Boulevard, CA; Campo, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922090885. Details of each certification follow.

Federally qualified health center certification: CCN 051905

Legal name
SOUTHERN INDIAN HEALTH COUNCIL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1994
Last certification
Jan 1, 1994
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 18, 1982 in CA
Enrollment address
36350 Church Rd
Campo, CA 91906-2715

Other NPIs with the same Medicare PAC ID 1

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

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

Locations

4058 Willows Rd
Alpine, CA 91901

5005 Willows Rd
Ste J
Alpine, CA 91901

8 Crestwood Rd
Boulevard, CA 91905

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Terrance King Individual Corporate OfficerChief Financial Officer Mar 1, 2013
W-2 Managing EmployeeCfo Mar 1, 2013
Carlene Chamberlain Individual Corporate DirectorBoard Member Jan 1, 2006
Michael Garcia Individual Corporate DirectorBoard Member Jan 1, 1996
Gwen Parada Individual Corporate DirectorBoard Chairperson Jan 1, 2004

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731369600000",
    "number": "1922090885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4058 WILLOWS ROAD",
            "city": "ALPINE",
            "state": "CA",
            "postal_code": "919011668",
            "telephone_number": "619-445-1188",
            "fax_number": "619-659-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36350 CHURCH ROAD",
            "city": "CAMPO",
            "state": "CA",
            "postal_code": "919062715",
            "telephone_number": "619-445-1188",
            "fax_number": "619-659-3140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INDIAN HEALTH COUNCIL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "TERRANCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "619-445-1188"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Campo, CA

Sources for this page

Verify at the official NPI Registry.