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Bay Area Community Health

Organization Active NPI Federally Qualified Health Center (FQHC) · San Jose, CA

NPI 1962024059 · NPPES record last updated May 7, 2021

Key facts

NPI
1962024059
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
BAY AREA COMMUNITY HEALTH
Practice address
1066 S White Rd Ste 170
San Jose, CA 95127-3812
Phone
(408) 729-9700
NPI assigned
May 12, 2020
Organization subpart
Yes
Parent organization (as reported)
BAY AREA COMMUNITY HEALTH

Authorized official

Name
Jagat Sheth
Title
Chief Financial Officer
Phone
(510) 252-6810

Owners & managing parties with NPI records 10

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

Owned or controlled facilities with NPI records 3

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 31

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

View all 31

Change of ownership 1

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

Facilities with the same owner 3

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

Practitioners 106

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 106

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Federally qualified health center certification: CCN 751182

Legal name
BAY AREA COMMUNITY HEALTH
Doing business as
BACH FAMILY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 30, 2015
Last certification
Oct 30, 2015
Ownership / control type
Non-profit – church related
Most recent change of ownership
Jun 1, 2020 (1 total)
Organization structure
Corporation · Non-profit
Incorporated
Apr 18, 1990 in CA
Enrollment address
1066 S White Rd
Ste 170
San Jose, CA 95127-3812

All disclosed owners & managing parties 14

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

NameRoleSinceShare
David E Perez
Individual 		Corporate Director
Board Member		 Jan 28, 2018
Bay Area Community Health
Organization · Fremont, CA
Non-profit 		5% Or Greater Direct Ownership Interest Jun 1, 2020 100%
Operational/Managerial Control Nov 15, 2018 100%
Jagat Sheth
Individual 		Corporate Officer
Cfo		 Nov 15, 2018
W-2 Managing Employee
Cfo		 Nov 15, 2018
Operational/Managerial Control
Ceo		 Nov 15, 2018
Marvin L Wong
Individual 		Corporate Director
Board Member		 Aug 27, 2018
Kobin Lee
Individual 		Corporate Officer
Vice Chair / Board Member		 Nov 15, 2019
Corporate Director
Vice Chair / Board Member		 Nov 15, 2019
Jacqueline B Belser
Individual 		Corporate Officer
Secretary/Board Member		 Nov 15, 2018
Corporate Director
Secretary/Board Member		 Nov 15, 2018
Yueqin Feng
Individual 		Corporate Director
Board Member		 Nov 15, 2018
Zettie D Page
Individual 		Corporate Officer
Ceo		 Nov 15, 2018 90%
W-2 Managing Employee
Ceo		 Nov 15, 2018 90%
Operational/Managerial Control
Ceo		 Nov 15, 2018 90%
Sherland D Headley
Individual 		Corporate Director
Board Member		 Nov 15, 2018
Xianzhong Zhu
Individual 		Corporate Officer
Treasurer/Board Member		 Nov 15, 2018
Corporate Director
Treasurer/Board Member		 Nov 15, 2018
Brenda L Quillin
Individual 		Corporate Director
Board Member		 Nov 15, 2016
Stephanie J Reddell
Individual 		Corporate Director
Board Member		 Nov 15, 2018
Najia Hamid
Individual 		Corporate Director
Board Member		 Nov 15, 2018
Robert J Wyckoff
Individual 		Corporate Officer
Board Chair/Board Member		 Nov 15, 2018
Corporate Director
Board Chair/Board Member		 Nov 15, 2018

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Gilroy Health Clinic
Gilroy, CA · CCN 751868		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Monterey Plaza Health Clinic
San Jose, CA · CCN 751869		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020
Mt. Pleasant School Based Clinic
San Jose, CA · CCN 751867		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2020

Change-of-ownership history

DateEventCounterparty
Jun 1, 2020 Change of Ownership
This provider was the buyer		 Foothill Health Center Inc
CCN 751182 · CA · NPI 1538508015

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20210312002249 CA Part a Provider - Federally Qualified Health Center (FQHC) 1658349824 Practice locations: San Jose, CA

National Provider Directory

Tax ID family
Tri City Family Plannin (32 organizations share this tax ID)
Part of
Tri City Family Plannin

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Yes

Addresses

Primary practice location

1066 S White Rd Ste 170
San Jose, CA 95127-3812

Mailing address

40910 Fremont Blvd
Fremont, CA 94538-4375
Phone (510) 770-8040

Other identifiers

IdentifierTypeStateIssuer
1538508015MedicaidCA

Other names

  • BACH Family Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 7, 2021.

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620345600000",
    "number": "1962024059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40910 FREMONT BLVD",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945384375",
            "telephone_number": "510-770-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1066 S WHITE RD STE 170",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951273812",
            "telephone_number": "408-729-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA COMMUNITY HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAY AREA COMMUNITY HEALTH",
        "enumeration_date": "2020-05-12",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "SHETH",
        "authorized_official_first_name": "JAGAT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "510-252-6810"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538508015",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BACH Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Jose, CA

All providers in San Jose, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.