NPIMap

Organization Active NPI

South Bay Home Health Care, LLC

  • Home Health Agency
  • San Jose, CA
National Provider Identifier
1992063283
Registry record updated Apr 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
788890 Issued in CA
Legal business name
SOUTH BAY HOME HEALTH CARE, LLC
Practice address
551 Stockton Ave Ste C
San Jose, CA 95126-2432
Phone
(408) 775-4499
Fax
(800) 974-2797
NPI assigned
Apr 24, 2012
Last updated
Apr 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2021

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

Authorized official

Name
Mr. Edward Rubinstein, DPM
Title
Owner
Phone
(650) 787-2743

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 788890 CA Primary

Addresses

Primary practice location

551 Stockton Ave Ste C
San Jose, CA 95126-2432

Mailing address

551 Stockton Ave Ste C
San Jose, CA 95126-2432
Phone (408) 775-4499

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130214000096 CA Part A Provider - Home Health Agency 7618121963 Practice locations: San Jose, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992063283. Details of each certification follow.

Home health agency certification: CCN 053174

Legal name
SOUTH BAY HOME HEALTH CARE LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 8, 2018
Last certification
May 19, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Jan 12, 2012 in CA
Enrollment address
1741 Saratoga Ave 213
San Jose, CA 95129-5204

Care Compare: Home health agency

Medicare Care Compare
Listed as
South Bay Home Health Care, LLCCCN 053174 · All quality measures
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Jun 8, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory

Locations

1741 Saratoga Ave
Ste 213
San Jose, CA 95129
Phone (408) 775-4499

551 Stockton Ave
Ste C
San Jose, CA 95126
Phone (408) 775-4499

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Svetlana Stukov Individual Contracted Managing EmployeeAdministrator Jul 1, 2012 25%
Edward Rubinstein Individual 5% Or Greater Direct Ownership Interest Jan 12, 2012 100%
Corporate OfficerCeo Jan 12, 2012 25%
Marina Gocha Individual Contracted Managing EmployeeDPCS, Board Member Jul 1, 2012 50%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 18

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618272000000",
    "number": "1992063283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 STOCKTON AVE STE C",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951262432",
            "telephone_number": "408-775-4499",
            "fax_number": "800-974-2797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "551 STOCKTON AVE STE C",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951262432",
            "telephone_number": "408-775-4499",
            "fax_number": "800-974-2797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY HOME HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-24",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "RUBINSTEIN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "650-787-2743",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CA",
            "license": "788890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.