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Santa Ynez Band of Mission Indians

Organization Active NPI Federally Qualified Health Center (FQHC) · Santa Ynez, CA

NPI 1992779417 · NPPES record last updated Sep 18, 2013

Key facts

NPI
1992779417
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
SANTA YNEZ BAND OF MISSION INDIANS
Practice address
90 Via Juana Lane
Santa Ynez, CA 93460-9405
Phone
(805) 688-7070
Fax
(805) 686-2060
NPI assigned
Feb 13, 2006
Organization subpart
No

Authorized official

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

Practitioners 31

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

View all 31

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0868645Santa Ynez Tribal Health Clinic
90 Via Juana Rd, Santa Ynez, CA 93460		Certificate of waiverJun 20, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

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
Other · Non-profit
Enrollment address
90 Via Juana Lane
Santa Ynez, CA 93460-9679

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 Employee
Lead Biller		 Jan 1, 2000

Medicare enrollment records

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

National Provider Directory

Locations

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

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD
    Plans: 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)…

Specialties & licenses

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

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 identifiers

IdentifierTypeStateIssuer
FHC70024FMedicaidCA
ZZZ-540482OtherCABLUE SHIELD GROUP NUMBER

Other names

  • Santa Ynez Tribal Health Clinic Doing business as

Other providers in Santa Ynez, CA

All providers in Santa Ynez, CA · Federally Qualified Health Center (FQHC) in California

Sources for this page

Verify at the official NPI Registry.