INDIAN HEALTH CENTER OF SANTA CLARA VALLEY (NPI# 1114290780) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114290780 |
| Entity Type | Organization |
| Organization Name | INDIAN HEALTH CENTER OF SANTA CLARA VALLEY |
| Other Organization Name | INDIAN HEALTH CENTER OF SANTA CLARA VALLEY - FAMILY MEDICINE CENTER |
| Practice Address |
455 Oconnor Dr Ste 200 San Jose CA 95128-1632 |
| Mailing Address |
1333 Meridian Ave San Jose CA 95125-5212 |
| Practice Telephone | 4084453400 |
| Practice Fax Number | 4084481727 |
| Mailing Telephone | 4084453400 |
| Mailing Fax Number | 4084481727 |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2013-02-07 |
| Authorized Official Name | DR. ALDON WAYNE SCOTT (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 4084453400 |
| Authorized Official Credential | D. M. |
| Is Organization Subpart | Y |
| Parent Organization Name | INDIAN HEALTH CENTER OF SANTA CLARA VALLEY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
550001941 | CA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DELTA DENTAL | G01133-01 | 01 |
| CA | STATE PROGRAMS | FHC11833F | 01 |
| CA | MEDICARE PALMETTO | 55-1137 | 01 |
| CA | FHC11833F | 05 |
| Other Name | Type Code |
|---|---|
| Indian Health Center of Santa Clara Valley - Family Medicine Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821564485 | Indian Health Center of Santa Clara Valley | Clinic/Center | 9501 Malech Rd, San Jose, CA 95138 | 2018-10-22 |
| 1437607355 | Indian Health Center of Santa Clara Valley | Clinic/Center | 2039 Forest Ave Ste 204b, San Jose, CA 95128-4815 | 2016-09-20 |
| 1629462312 | Indian Health Center of Santa Clara Valley | Clinic/Center | 2039 Forest Ave Ste 105, San Jose, CA 95128-4815 | 2015-03-20 |
| 1275964488 | Indian Health Center of Santa Clara Valley | Clinic/Center | 1685 Westwood Dr Ste 1, San Jose, CA 95125 | 2013-12-13 |
| 1538529052 | Indian Health Center of Santa Clara Valley | Clinic/Center | 25 N 14th St Ste 140, San Jose, CA 95112-6218 | 2016-02-25 |
| 1326425265 | Indian Health Center of Santa Clara Valley | Clinic/Center | 2030 Forest Ave Ste 110, San Jose, CA 95128-4833 | 2015-04-29 |
| 1366726903 | Indian Health Center of Santa Clara Valley | Clinic/Center | 602 E Santa Clara St, San Jose, CA 95112-1908 | 2011-09-30 |
| 1518240118 | Indian Health Center of Santa Clara Valley | Clinic/Center | 602 E Santa Clara St, Suite 230, San Jose, CA 95112-1908 | 2011-09-21 |
| 1881997963 | Indian Health Center of Santa Clara Valley | Clinic/Center | 1642 E Capitol Expy, San Jose, CA 95121-1800 | 2010-12-13 |
| 1629236500 | Indian Health Center of Santa Clara Valley | Clinic/Center | 602 E Santa Clara St, Suite 230, San Jose, CA 95112-1908 | 2008-05-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | INDIAN HEALTH CENTER OF SANTA CLARA VALLEY | 1333 Meridian Ave, San Jose, CA 95125-5212 |
| Street Address |
455 OCONNOR DR STE 200 |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95128-1632 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366682767 | Bernadette Teresa Ansolabehere | Family Medicine | 455 Oconnor Dr Ste 200, San Jose, CA 95128-1632 | 2009-02-24 |
| 1770011348 | Matilde Fredrickson | Student in an Organized Health Care Education/Training Program | 455 Oconnor Dr Ste 200, San Jose, CA 95128-1632 | 2017-05-26 |
| 1104205087 | Stephen Vogel | Family Medicine | 455 Oconnor Dr Ste 200, San Jose, CA 95128-1632 | 2015-05-25 |
| 1144663964 | Kelly Ann Welsh | Family Medicine | 455 Oconnor Dr Ste 200, San Jose, CA 95128-1632 | 2013-04-10 |
| 1689925703 | Enoch Yoon | Family Medicine | 455 Oconnor Dr Ste 200, San Jose, CA 95128-1632 | 2012-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982227138 | Ruth Larsen | Social Worker | 850 S. Bascom Avenue, Suite 280, San Jose, CA 95128 | 2020-05-22 |
| 1265067185 | Of Two Minds Psychotherapy | Marriage & Family Therapist | 190 S. Bascom Ave, Ste 130, San Jose, CA 95128 | 2020-03-11 |
| 1982244166 | Cindy Pantoja Escobar | Behavior Technician | 100 O'connor Drive, Suites 21, San Jose, CA 95128 | 2020-01-15 |
| 1104460591 | Katherine Alexandra Misogas | Pharmacist | 777 Turner Dr # 330, San Jose, CA 95128 | 2019-10-29 |
| 1942842216 | Jodie Pierce | Marriage & Family Therapist | 871 Enborg Lane, San Jose, CA 95128 | 2019-10-08 |
| 1003466434 | Dong Mi Cha | Pharmacist | 777 Turner Dr Ste 330, San Jose, CA 95128 | 2019-09-17 |
| 1114571759 | Sleep Well Acupuncture, Inc | Acupuncturist | 1361 S Winchester Blvd Suite 206, San Jose, CA 95128 | 2019-08-01 |
| 1083277677 | Wellocity, Inc | Health Educator | 334 Santana Row, 318, San Jose, CA 95128 | 2019-04-18 |
| 1518428812 | Alexander Diaz | Radiology | 75 South Bascom Ave, San Jose, CA 95128 | 2019-03-28 |
| 1720542103 | Nanci R Price Inc | Chiropractor | 100 O'connor Dr., Ste 27, San Jose, CA 95128 | 2019-01-30 |
| Find all providers in zip 95128 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669094504 | Bay Area Community Health | Clinic/Center | 3434 Silver Creek Rd Rm M1, San Jose, CA 95121-1845 | 2020-05-14 |
| 1720600760 | Bay Area Community Health | Clinic/Center | 2880 Story Rd Ste 10, San Jose, CA 95127-3942 | 2020-05-13 |
| 1487276424 | Bay Area Community Health | Clinic/Center | 242 La Pala Dr Ste A&b, San Jose, CA 95127-2103 | 2020-05-13 |
| 1598387672 | Bay Area Community Health | Clinic/Center | 3200 Senter Rd Rm S104, San Jose, CA 95111-1332 | 2020-05-12 |
| 1962024059 | Bay Area Community Health | Clinic/Center | 1066 S White Rd Ste 170, San Jose, CA 95127-3812 | 2020-05-12 |
| 1407478597 | Bay Area Community Health | Clinic/Center | 1855 Lucretia Ave Bldg M, San Jose, CA 95122-3730 | 2020-05-12 |
| 1659993632 | Bay Area Community Health | Clinic/Center | 617 N Jackson Ave Bldg 1, San Jose, CA 95133-2345 | 2020-05-12 |
| 1821564485 | Indian Health Center of Santa Clara Valley | Clinic/Center | 9501 Malech Rd, San Jose, CA 95138 | 2018-10-22 |
| 1770027047 | San Jose Foothill Family Community Clinic, Inc. | Clinic/Center | 3434 Silver Creek Rd, Room M1, San Jose, CA 95121-1845 | 2016-12-06 |
| 1437607355 | Indian Health Center of Santa Clara Valley | Clinic/Center | 2039 Forest Ave Ste 204b, San Jose, CA 95128-4815 | 2016-09-20 |
| Find all providers in SAN JOSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.