CentroMed Southside Medical Clinic – Federally Qualified Health Center (FQHC), NPI 1104998749
Federally Qualified Health Center (FQHC)
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for CentroMed Southside Medical Clinic
The Avenue, 715, Pacific Avenue, Downtown District (Commercial), Downtown, Santa Cruz, Santa Cruz County, California, 1982, United States
SAN ANTONIO, TX 782213117
Phone: (210) 334-3700
Fax: (210) 922-0162
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-03-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-06-30 (19 days away).
Enrollment records
1
Earliest due date
2026-06-30
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20050303000520 | O | Federally Qualified Health Center (Fqhc) | TX | 2026-06-30 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 78221)
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