NPIMap

Organization Active NPI

Santa Ynez Band of Mission Indians

Doing business as Santa Ynez Tribal Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Santa Ynez, CA
National Provider Identifier
1992779417
Registry record updated Sep 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SANTA YNEZ BAND OF MISSION INDIANS
Doing business as
Santa Ynez Tribal Health Clinic
Practice address
90 Via Juana Lane
Santa Ynez, CA 93460-9405
Phone
(805) 688-7070
Fax
(805) 686-2060
NPI assigned
Feb 13, 2006
Last updated
Sep 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2013

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

Authorized official

Name
Ms. Jennifer Jasso
Title
Finacial Services Manager
Phone
(805) 688-7070

Specialties & licenses 1

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

Addresses

Primary practice location

90 Via Juana Lane
Santa Ynez, CA 93460-9405

Mailing address

PO Box 539
Santa Ynez, CA 93460-0539
Phone (805) 688-7070

Other names 1

  • Santa Ynez Tribal Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040506001569 CA Part A Provider - Federally Qualified Health Center (FQHC) 7618966516 Practice locations: Santa Ynez, CA
O20141114000692 CA Part B Supplier - Clinic/Group Practice 7618966516 Receives reassigned benefits from 10 practitioners
Practice locations: Santa Ynez, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992779417. Details of each certification follow.

Federally qualified health center certification: CCN 051903

Legal name
SANTA YNEZ BAND OF MISSION INDIANS
Doing business as
SANTA YNEZ TRIBAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1994
Last certification
Jan 1, 1994
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
90 Via Juana Lane
Santa Ynez, CA 93460-9679

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
05D0868645Santa Ynez Tribal Health Clinic90 Via Juana Rd, Santa Ynez, CA 93460Certificate of waiverJun 20, 2027

National Provider Directory

National Provider Directory

Locations

90 Via Juana Rd
Santa Ynez, CA 93460
Phone (805) 688-7070

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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
Briana Young Individual Corporate Director Apr 1, 2012
Rosey Bramsen Individual W-2 Managing EmployeeLead Biller Jan 1, 2000

Practitioners & affiliated clinicians

Practitioners 31

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.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379462400000",
    "number": "1992779417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 539",
            "city": "SANTA YNEZ",
            "state": "CA",
            "postal_code": "934600539",
            "telephone_number": "805-688-7070",
            "fax_number": "805-686-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 VIA JUANA LANE",
            "city": "SANTA YNEZ",
            "state": "CA",
            "postal_code": "934609405",
            "telephone_number": "805-688-7070",
            "fax_number": "805-686-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA YNEZ BAND OF MISSION INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-13",
        "last_updated": "2013-09-18",
        "status": "A",
        "authorized_official_last_name": "JASSO",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "FINACIAL SERVICES MANAGER",
        "authorized_official_telephone_number": "805-688-7070",
        "authorized_official_name_prefix": "Ms."
    },
    "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": "Santa Ynez Tribal Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Ynez, CA

Sources for this page

Verify at the official NPI Registry.