NPIMap

Organization Active NPI

Centro de Salud de la Comunidad de San Ysidro,Inc

Doing business as San Ysidro Health Physicians Health Institute for Women

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1962177873
Registry record updated Nov 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO,INC
Doing business as
San Ysidro Health Physicians Health Institute for Women
Practice address
550 Washington St Ste 331
San Diego, CA 92103-2227
Phone
(619) 662-4100
NPI assigned
Aug 12, 2021
Reactivated
Nov 21, 2022
Last updated
Nov 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2022

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

Authorized official

Name
William Brian Wallace
Title
Cfo
Phone
(619) 205-6339

Specialties & licenses 1

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

Addresses

Primary practice location

550 Washington St Ste 331
San Diego, CA 92103-2227

Mailing address

1601 Precision Park LN
San Diego, CA 92173-1345
Phone (619) 662-4100

Other names 1

  • San Ysidro Health Physicians Health Institute for Women Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130000711 CA Part B Supplier - Clinic/Group Practice 6901709435 Receives reassigned benefits from 611 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: National City, CA; San Diego, CA; San Ysidro, CA; Santee, CA; Vista, CA; Alpine, CA; Campo, CA; Chula Vista, CA…

Other NPIs on the same Medicare enrollment 40

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

View all 40

National Provider Directory

National Provider Directory

Locations

550 Washington St
Ste 331
San Diego, CA 92103
Phone (619) 297-5437

120 Town Center Pkwy
Santee, CA 92071
Phone (619) 645-0121

Practitioners & affiliated clinicians

Practitioners 5

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": "1628726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668988800000",
    "number": "1962177873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 PRECISION PARK LN",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921731345",
            "telephone_number": "619-662-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 WASHINGTON ST STE 331",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032227",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-12",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "deactivation_date": "2022-11-07",
        "reactivation_date": "2022-11-21",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "619-205-6339"
    },
    "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": "San Ysidro Health Physicians Health Institute for Women",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; 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.