Primary Care Clinic - Consolidated
Change of National Provider Identifier Application Packet
A State license is required to operate as a Primary Care Clinic (PCC) - Consolidated in California. A PCC ā Consolidated means allowing eligible PCCs or affiliate clinics to add additional physical plants, maintained and operated on separate premises, to an existing PCC or affiliate clinic site. The PCC or affiliate clinic license shall be amended to include the additional physical plant as part of a single consolidated license. A PCC or affiliate clinic may add additional locations that are no more than one-half mile from the licensed clinic adding the additional physical plant under the consolidated license. Refer to Health and Safety Code (HSC) sections 1200 through 1245 for information regarding licensure requirements.
To report a Change of National Provider Identifier (NPI), you must complete the required application packet. Refer to Title 42 of the Code of Federal Regulations section 424.506 for information regarding NPI enrollment requirements.
How to Apply
An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The application packet contains the required forms in one location. The provider checklist identifies the required forms and supporting documents needed to apply for licensing and certification. The provider instructions are a resource to guide you through the process.
Please refer to the following links to get started:
Application Packet Formsā
Where to Submit Applications
Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.
California Department of Public Health
Licensing and Certification Division
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899-7377