NPIMap

Organization Active NPI

Wellspace Health

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
National Provider Identifier
1932663192
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WELLSPACE HEALTH
Practice address
3946 Norwood Ave
Sacramento, CA 95838-3300
Phone
(916) 564-0521
Fax
(877) 860-2907
NPI assigned
Jan 22, 2019
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Dr. Aladiar Jonathan Porteus, PHD.
Title
Chief Executive Officer
Phone
(916) 313-8413

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Contractor 171W00000X NU
Developmentally Disabled Services Day Training Agency 251C00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X NU
Home Delivered Meals 332U00000X NU
Personal Care Attendant 3747P1801X NU
Respite Care 385H00000X NU
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

3946 Norwood Ave
Sacramento, CA 95838-3300

Mailing address

777 12TH St Ste 250
Sacramento, CA 95814-1929
Phone (916) 550-5481

Other names 1

  • WellSpace Health Norwood Community Health Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070623000117 CA Part B Supplier - Clinic/Group Practice 8426157975 Receives reassigned benefits from 123 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sacramento, CA; Jackson, CA; Citrus Heights, CA; Folsom, CA; North Highlands, CA; Roseville, CA
O20200304002466 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426157975 Practice locations: Sacramento, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932663192. Details of each certification follow.

Federally qualified health center certification: CCN 921842

Legal name
WELLSPACE HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 18, 2020
Last certification
Feb 18, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 7, 1970 in CA
Enrollment address
3946 Norwood Ave
Sacramento, CA 95838-3300

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 23

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

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0881546Wellspace Health Norwood3946 Norwood Ave, Sacramento, CA 95838Certificate of waiverOct 6, 2026

National Provider Directory

National Provider Directory
Tax ID family
Wellspace Health Professional Health Center for Women42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

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

View all 41

Locations

2433 Marconi Ave
Sacramento, CA 95821
Phone (916) 313-8455

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Todd Murray Individual Corporate Officer Jul 1, 2019
Lawrence Maas Individual Corporate Officer Jul 1, 2019
Lisa Stewart Individual Corporate Director Jul 1, 2019
Timothy Martin Individual Corporate Director Jul 1, 2019
James Tilton Individual Corporate Officer Jul 1, 2019
Jonathan a Porteus Individual Contracted Managing Employee Sep 1, 2007
Corporate Officer Jan 1, 2011
Corporate Director Jan 1, 2011
Ruzwa Cooper Individual Corporate Officer Jul 1, 2019
Janine Vivienne Bera Individual Contracted Managing Employee Jun 1, 2017
Corporate Officer Jun 1, 2017
Corporate Director Jun 1, 2017
Wellspace Health Organization, Sacramento, CA Corporation, Non-profit Operational/Managerial Control Feb 7, 1970
Michael Hunter Individual Corporate Director Jul 1, 2019

Owners & managing parties with NPI records 17

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 17

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Wellspace HealthSacramento, CA, CCN 051142 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health North Highlands Community Health CenterNorth Highlands, CA, CCN 551020 Federally qualified health center Operational/Managerial Control Nov 27, 2011
Wellspace HealthSacramento, CA, CCN 551021 Federally qualified health center Operational/Managerial Control Jan 4, 2010
Wellspace HealthSacramento, CA, CCN 551022 Federally qualified health center Operational/Managerial Control May 17, 2010
Wellspace HealthRoseville, CA, CCN 751000 Federally qualified health center Operational/Managerial Control Mar 16, 2012
Wellspace Health Healthcare for Women Community Health CenterSacramento, CA, CCN 921070 Federally qualified health center 5% Or Greater Indirect Ownership Interest (100%) Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921843 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace HealthSacramento, CA, CCN 921841 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sunrise CommunityCitrus Heights, CA, CCN 921844 Federally qualified health center Operational/Managerial Control Feb 7, 1970
Wellspace Health Sierra Garden 2Roseville, CA, CCN 921840 Federally qualified health center Operational/Managerial Control Feb 7, 1970

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

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": "1548115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1932663192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 12TH ST STE 250",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958141929",
            "telephone_number": "916-550-5481",
            "fax_number": "916-520-3921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3946 NORWOOD AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958383300",
            "telephone_number": "916-564-0521",
            "fax_number": "877-860-2907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLSPACE HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-22",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "PORTEUS",
        "authorized_official_first_name": "ALADIAR",
        "authorized_official_middle_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "916-313-8413",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "",
            "desc": "Technician, Personal Care Attendant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellSpace Health Norwood Community Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "WellSpace Health Norwood Community Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.