Southern Indian Health Council
Organization Active NPI Health Service Clinic/Center · Campo, CA
NPI 1922090885 · NPPES record last updated Nov 12, 2024
Key facts
- NPI
- 1922090885
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Service Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Terrance A King
- Title
- Cfo
- Phone
- (619) 445-1188
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 1
Practitioners 44
-
Joshua Matthew Blessing, M.D.
-
Robert T. Calvert, D.O.
-
Karl Monte Jacobs, M.D.
-
Kathryn Denine Krug, LMFT
-
Sheila Malekian, MD
-
Kassandra Marie Mason, LMFT
-
Tricia Denise Neill, CADC-I
-
Anthonia O Okoh, DNP
-
Niloufar Salehi, D.O.
-
Peter M Seymour, MD
-
Julie Woochuk, CADC-II
-
Steve Granada, M.D.
-
James Grebosky, MD
-
Rene Gaeta, RD
-
Dustin Hayes Kessler, AMFT, CADC-III
-
Joseph Anthony Buckner, PA-C
-
Shelly Delgado Aledo, LCSW
-
Alexa K Hall, LCSW
-
Anita Koo, O.D.
-
Josephine Hoa Ngoc Mai, PA-C
-
Majid Mani, M.D.
-
Ryan Tsain Marr, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, TX
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
- Corporation · Non-profit
- Incorporated
- Nov 18, 1982 in CA
- Enrollment address
- 36350 Church Rd
Campo, CA 91906-2715
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Terrance King |
Corporate Officer |
Mar 1, 2013 | |
| W-2 Managing Employee |
Mar 1, 2013 | ||
| Carlene Chamberlain |
Corporate Director |
Jan 1, 2006 | |
| Michael Garcia |
Corporate Director |
Jan 1, 1996 | |
| Gwen Parada |
Corporate Director |
Jan 1, 2004 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
5005 Willows Rd
Ste J
Alpine, CA 91901
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | Yes |
Addresses
Primary practice location
36350 Church Road
Campo, CA 91906-2715
Mailing address
4058 Willows Road
Alpine, CA 91901-1668
Phone (619) 445-1188
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| THP80243F | Medicaid | CA |
Other providers in Campo, CA
- Richard Adali Shaplin
- Tim Shaplin
- Colin Sheehan
- Gerald R Shirey III
- Southern Indian Health Council
- Anthony Stracener
- Gabriel Bermudez Tabarez
- Selina Thomas
- Jennifer Vanderschaegen
- John Vargas
All providers in Campo, CA · Health Service Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.