NPIMap

Organization Active NPI

Gardner Family Health Network

Doing business as Specialty Mental Health Alviso

  • Community Health Clinic/Center
  • Alviso, CA
National Provider Identifier
1922625847
Registry record updated Aug 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
GARDNER FAMILY HEALTH NETWORK
Doing business as
Specialty Mental Health Alviso
Practice address
1621 Gold St
Alviso, CA 95002-3530
Phone
(408) 935-3900
NPI assigned
Jun 26, 2020
Last updated
Aug 11, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
GARDNER FAMILY HEALTH NETWORKAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 11, 2020

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

Authorized official

Name
Christina Cornell
Title
Credentialing Supervisor
Phone
(408) 579-6178

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU Primary

Addresses

Primary practice location

1621 Gold St
Alviso, CA 95002-3530

Mailing address

160 E Virginia St Ste 100
San Jose, CA 95112-5865

Other names 1

  • Specialty Mental Health Alviso Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191217001965 CA Part B Supplier - Clinic/Group Practice 5890859375 Receives reassigned benefits from 37 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alviso, CA; San Jose, CA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Family Health Fndtn Alv33 organizations share this tax ID, including this one
Part of
Family Health Fndtn Alv

Other organizations with this tax ID 32

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

View all 32

Locations

160 E Virginia St
Ste 100
San Jose, CA 95112
Phone (408) 918-2618

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597104000000",
    "number": "1922625847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST STE 100",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1621 GOLD ST",
            "city": "ALVISO",
            "state": "CA",
            "postal_code": "950023530",
            "telephone_number": "408-935-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARDNER FAMILY HEALTH NETWORK",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GARDNER FAMILY HEALTH NETWORK",
        "enumeration_date": "2020-06-26",
        "last_updated": "2020-08-11",
        "certification_date": "2020-08-11",
        "status": "A",
        "authorized_official_last_name": "CORNELL",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "408-579-6178"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Specialty Mental Health Alviso",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alviso, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2020; 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.