ELICA HEALTH CENTERS - MACK ROAD
NPI 1154947711
Clinic/Center - Federally Qualified Health Center (FQHC) in Sacramento, CA
About Elica Health Centers - Mack Road NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ELICA HEALTH CENTERS - MACK ROAD (NPI 1154947711) is a healthcare organization registered as a federally qualified health center (fqhc) in Sacramento, California and active in the NPI registry since June 2020. The organization holds 4 active CLIA laboratory certificates and lists Tatyana Bak, Ceo, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Elica Health Centers - Mack Road is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
90Medicare enrollment records show 90 clinicians reassign Medicare billing to Elica Health Centers - Mack Road, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 58 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 13
Nearest to this location (20)
See all 90Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA 4
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2189007
Elica Health Centers - Mack Road · Sacramento, CACertificate of Waiver 05D2189802
Elica Health Centers - Cadillac Drive · Sacramento, CACertificate of Waiver 05D2180682
Elica Health Centers On Wheels 3 (vin #4uzacmfc8jckg6989) · West Sacramento, CACertificate of Waiver 05D2280133
Elica Health Centers V Street Medical Center · Sacramento, CAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Elica Health Centers's NPI number?
The NPI number for Elica Health Centers is 1154947711. It was assigned to this organization in the NPPES registry on June 19, 2020. The provider is also known as Elica Health Centers - Mack Road.
Where is Elica Health Centers located?
Elica Health Centers is located at 6339 Mack Rd, Sacramento, CA 95823. The listed phone number is (916) 454-2345.
What is Elica Health Centers's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is Elica Health Centers enrolled in Medicare?
Yes. Elica Health Centers is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Elica Health Centers?
According to the CMS Revalidation Reassignment List (October 2026 release), 90 clinicians in 13 Medicare specialties reassign their Medicare billing to Elica Health Centers. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (31), Family Practice (12) and Pediatric Medicine (11). Of these, 1 practice at this address and 58 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Elica Health Centers hold CLIA laboratory certificates?
Yes. 4 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
When was this NPI record last updated?
The NPPES record for Elica Health Centers was last updated on March 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Elica Health Centers - Mack Road · NPI 1154947711
Federally Qualified Health Center (FQHC) organization in Sacramento, California. Organization record, active in the CMS NPPES registry since June 19, 2020.
## Identity
- **NPI:** 1154947711 (Entity type: Organization)
- **Enumerated:** June 19, 2020
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Legal business name:** Elica Health Centers
- **Organization subpart:** Yes (part of Elica Health Centers)
- **Authorized official:** Tatyana Bak, CEO
## Practice location
- **Address:** 6339 MACK RD, Sacramento, CA 95823-4655
- **Phone:** (916) 454-2345 · **Fax:** (916) 890-3828
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 90 clinicians in 13 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (31), Family Practice (12), Pediatric Medicine (11); 1 practice at this address and 58 within 10 miles; [full list](https://npiprofile.com/npi/1154947711/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** March 8, 2022
- **CLIA laboratory certificates:** 4 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1154947711) · Data from the CMS NPPES public registry.