San Jose Foothill Family Community Clinic, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC

Practice address

5504 Monterey Hwy
San Jose, CA 95138-1529

Phone

(408) 729-9700

NPI assigned

Apr 28, 2015

Organization subpart

Yes

Parent organization

SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INCAs reported in NPPES

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

Authorized official

Name

Salvador Chavarin

Title

Chief Executive Officer

Phone

(408) 729-4240

Specialties & licenses 1

Addresses

Other names 1

• Monterey Plaza Health Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Part of

San Jose Foothill Family Community Clinic

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Bay Area Community Health

  • Federally Qualified Health Center (FQHC)
  • San Jose, CA
  • NPI 1598387680

  Sold to, 2020-06-01

  CMS change of ownership

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

{
    "created_epoch": "1430179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430265600000",
    "number": "1922485952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 S WHITE RD",
            "address_2": "SUITE 200",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951482071",
            "telephone_number": "408-729-4240",
            "fax_number": "866-931-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5504 MONTEREY HWY",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951381529",
            "telephone_number": "408-729-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN JOSE FOOTHILL FAMILY COMMUNITY CLINIC, INC",
        "enumeration_date": "2015-04-28",
        "last_updated": "2015-04-29",
        "status": "A",
        "authorized_official_last_name": "CHAVARIN",
        "authorized_official_first_name": "SALVADOR",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "408-729-4240"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monterey Plaza Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• San Jose Doctors on Duty
• San Jose Eye Care Optometry Professional Corporation
• San Jose Eye Institute Medical Corporation
• San Jose Family Health Center
• San Jose Foothill Family Community Clinic
• San Jose Foothill Family Community Clinic, Inc.
• San Jose Foothill Family Community Clinic, Inc.
• San Jose Foothill Family Community Clinic, Inc.
• San Jose Foothill Family Community Clinic, Inc.
• San Jose Foothill Family Community Clinic, Inc.

• Federally Qualified Health Center (FQHC) in San Jose, CA
• Providers in San Jose, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.