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Organization Active NPI

Tule River Indian Health Center, Inc.

  • Family Medicine Physician
  • Porterville, CA
National Provider Identifier
1972586972
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
01185 Issued in CA
Legal business name
TULE RIVER INDIAN HEALTH CENTER, INC.
Practice address
380 N Reservation Rd
Porterville, CA 93257-9673
Phone
(559) 784-2316
Fax
(559) 791-2533
NPI assigned
Nov 22, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
Sylvia Jimenez, MBA
Title
Staff Accountant
Phone
(559) 791-2549

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 01185 CA Primary

Addresses

Primary practice location

380 N Reservation Rd
Porterville, CA 93257-9673

Mailing address

PO Box 768
Porterville, CA 93258-0768
Phone (559) 784-2316

Other identifiers 1

IdentifierTypeStateIssuer
051092OtherCAMEDICARE FQHC

Other names 1

  • Tule River Health Center, Inc. Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070510000225 CA Part A Provider - Federally Qualified Health Center (FQHC) 0547366346 Practice locations: Porterville, CA
O20240702003354 TX Part B Supplier - Clinic/Group Practice 0547366346 Receives reassigned benefits from 1 practitioner
Practice locations: Porterville, CA

Federally qualified health center certification: CCN 051092

Legal name
TULE RIVER INDIAN HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 2, 2007
Last certification
Jul 2, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 5, 1973 in CA
Enrollment address
380 N Reservation Rd
Porterville, CA 93257-9673

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Tule River Indian Health Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Larry Barnes Individual W-2 Managing EmployeeAd; Mar 11, 2025 50%
Miku Sodhi Individual 5% Or Greater Direct Ownership InterestCeo Apr 28, 2025 5%
Corporate OfficerCeo Apr 28, 2025 100%
W-2 Managing EmployeeCeo Apr 28, 2025 100%

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1972586972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 768",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932580768",
            "telephone_number": "559-784-2316",
            "fax_number": "559-791-2533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 N RESERVATION RD",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932579673",
            "telephone_number": "559-784-2316",
            "fax_number": "559-791-2533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULE RIVER INDIAN HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-22",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "JIMENEZ",
        "authorized_official_first_name": "SYLVIA",
        "authorized_official_title_or_position": "STAFF ACCOUNTANT",
        "authorized_official_telephone_number": "559-791-2549",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "01185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE FQHC",
            "identifier": "051092",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tule River Health Center, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Porterville, CA

Sources for this page

Verify at the official NPI Registry.