DAVIS STREET PRIMARY CARE CLINIC
NPI 1215358924
Clinic/Center - Federally Qualified Health Center (FQHC) in San Leandro, CA
About Davis Street Primary Care Clinic NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DAVIS STREET PRIMARY CARE CLINIC (NPI 1215358924) is a healthcare organization registered as a federally qualified health center (fqhc) in San Leandro, California and active in the NPI registry since December 2013. The organization lists Rosalia Aquino Mcmillen, Chief Fiscal Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 4
Other Names 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)
Davis Street Primary Care Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
42Medicare enrollment records show 42 clinicians reassign Medicare billing to Davis Street Primary Care Clinic, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 14 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 14
Nearest to this location (20)
See all 42Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently 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 The Davis Street Community Center Incorporated's NPI number?
The NPI number for The Davis Street Community Center Incorporated is 1215358924. It was assigned to this organization in the NPPES registry on December 23, 2013. The provider is doing business as Davis Street Primary Care Clinic.
Where is The Davis Street Community Center Incorporated located?
The Davis Street Community Center Incorporated is located at 3081 Tegarden, San Leandro, CA 94577. The listed phone number is (510) 347-4620.
What is The Davis Street Community Center Incorporated's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is The Davis Street Community Center Incorporated enrolled in Medicare?
Yes. The Davis Street Community Center Incorporated is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through The Davis Street Community Center Incorporated?
According to the CMS Revalidation Reassignment List (October 2026 release), 42 clinicians in 14 Medicare specialties reassign their Medicare billing to The Davis Street Community Center Incorporated. 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 (15), Dentist (8) and Internal Medicine (4). Of these, 6 practice at this address and 14 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for The Davis Street Community Center Incorporated was last updated on April 1, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Davis Street Primary Care Clinic · NPI 1215358924
Federally Qualified Health Center (FQHC) organization in San Leandro, California. Organization record, active in the CMS NPPES registry since December 23, 2013.
## Identity
- **NPI:** 1215358924 (Entity type: Organization)
- **Enumerated:** December 23, 2013
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Legal business name:** The Davis Street Community Center Incorporated
- **Organization subpart:** No
- **Authorized official:** Rosalia Mcmillen, CHIEF FISCAL OFFICER
## Practice location
- **Address:** 3081 TEGARDEN, San Leandro, CA 94577-5720
- **Phone:** (510) 347-4620 · **Fax:** (510) 486-4486
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 42 clinicians in 14 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (15), Dentist (8), Internal Medicine (4); 6 practice at this address and 14 within 10 miles; [full list](https://npiprofile.com/npi/1215358924/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 1, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1215358924) · Data from the CMS NPPES public registry.