NPIMap

Organization Active NPI

Southern California Healthcare System, Inc

Doing business as Southern California Hospital at Hollywood, at Van Nuys, at Culver City

  • General Acute Care Hospital
  • Hollywood, CA
National Provider Identifier
1023010113
Registry record updated Feb 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
930000066 Issued in CA
Legal business name
SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC
Doing business as
Southern California Hospital at Hollywood, at Van Nuys, at Culver City
Practice address
6245 De Longpre Ave
Hollywood, CA 90028-8253
Phone
(323) 462-2271
Fax
(323) 463-3830
NPI assigned
Jun 2, 2005
Last updated
Feb 4, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ALTA HOSPITALS SYSTEM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jon Zilkow
Title
Chief Financial Officer
Phone
(310) 943-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 930000066 CA Primary

Addresses

Primary practice location

6245 De Longpre Ave
Hollywood, CA 90028-8253

Mailing address

3415 S Sepulveda Blvd FL 9
Los Angeles, CA 90034-6060
Phone (310) 943-4500

Other identifiers 4

IdentifierTypeStateIssuer
HSP40135IMedicaidCA
ZZZC9928ZOtherCABLUE SHEILD
HSP30135IMedicaidCA
HSC30135IMedicaidCA

Other names 1

  • Southern California Hospital at Hollywood, at Van Nuys, at Culver City Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041005000875 CA Part A Provider - Hospital 8022077148 Practice locations: Culver City, CA; Van Nuys, CA; Hollywood, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023010113. Details of each certification follow.

Hospital certification: CCN 050135

Legal name
SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC
Doing business as
SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jan 19, 1976
Last certification
Feb 18, 2023
Beds
579
Ownership / control type
Private (for profit)
Most recent change of ownership
Oct 1, 1998 (1 total)
Organization structure
CorporationProprietary
Incorporated
May 29, 1998 in CA
Enrollment address
6245 De Longpre Ave
Hollywood, CA 90028-8253
Other Hospital Practice Location
Hospital subgroups
General, Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Southern California Hospital at HollywoodCCN 050135 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0543155Southern California Hospital at Hollywood6245 De Longpre Ave, Los Angeles, CA 90028AccreditationAug 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
Southern California Healthcare System Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 20

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sang Bum Lee Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2012 66.67%
Corporate OfficerPresident Dec 31, 2012
Corporate DirectorDirector Dec 31, 2012
MPT of Van Nuys PMH, L.P. Organization, Birmingham, AL 5% Or Greater Indirect Ownership Interest Aug 23, 2019 100%
Robert Elders Individual Corporate OfficerSecretary Jun 15, 2020
Michael Klepin Individual Corporate OfficerHospital Ceo May 13, 2018
MPT of Culver City PMH, L.P. Organization, Birmingham, AL 5% Or Greater Indirect Ownership Interest Aug 23, 2019 100%
JP Morgan Chase, N.a. Organization, Columbus, OH Financial institution 5% Or Greater Security Interest Jun 30, 2016 100%
Eric Samuels Individual Corporate OfficerTreasurer Jun 3, 2019
Ivy Intermediate Holding Inc Organization, Los Angeles, CA Non-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2012 100%
Alfredo Sabillo Individual Corporate OfficerAssistant Treasurer Jul 21, 2020
Mark Johnson Individual Corporate OfficerSVP Jul 27, 2020
Ivy Holdings Inc Organization, Los Angeles, CA Non-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2012 100%
William M Gorenstein Individual Corporate OfficerSVP Aug 15, 2016
Alta Hospitals System LLC Organization, Los Angeles, CA For-profit 5% Or Greater Direct Ownership Interest Aug 8, 2007 100%
David & Alexa Topper Family Trust Organization, Beverly Hills, CA 5% Or Greater Indirect Ownership Interest Dec 31, 2012 33.33%
Michel Bennett McGinty Individual W-2 Managing EmployeeHospital Cno Jan 22, 2019
David R Topper Individual Corporate OfficerCeo Dec 31, 2012
Corporate DirectorDirector Dec 31, 2012
Other Dec 31, 2012
Southern California Healthcare System, Inc Organization, Hollywood, CA For-profit 5% Or Greater Direct Ownership Interest May 29, 1998 100%
Chamber Inc Organization, Los Angeles, CA Corporation 5% Or Greater Indirect Ownership Interest Jun 1, 2021 100%
Prospect Medical Holdings Inc Organization, Los Angeles, CA Non-profit 5% Or Greater Indirect Ownership Interest Dec 31, 2012 100%
MPT of Hollywood PMH, L.P. Organization, Birmingham, AL 5% Or Greater Indirect Ownership Interest Aug 23, 2019 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southern California Hospital at Culver CityCulver City, CA, CCN 05T135 Hospital 5% Or Greater Direct Ownership Interest (100%) May 29, 1998
Southern California Hospital at Culver CityCulver City, CA, CCN 555874 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) May 29, 1998

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 12

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Alta Los Angeles Hospitals, Inc.

    dba Los Angeles Comm Hosp, Norwalk Comm Hosp & LA Comm Hosp at Bellflower

    • General Acute Care Hospital
    • Los Angeles, CA
    • NPI 1922001809

    Alta Hospitals System LLC, Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Alta Newport Hospital, LLC

    dba Foothill Regional Medical Center

    • Pediatric Skilled Nursing Facility
    • Tustin, CA
    • NPI 1689096406

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Southern California Healthcare System, Inc

    dba Southern California Hospital at Culver City

    • Rehabilitation Hospital Unit
    • Culver City, CA
    • NPI 1861744138

    Alta Hospitals System LLC, Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding Inc, MPT of Culver City PMH, L.P., MPT of Hollywood PMH, L.P., MPT of Van Nuys PMH, L.P., Prospect Medical Holdings Inc, Souther

    CMS ownership
  • Southern California Healthcare System, Inc

    dba Southern California Hospital at Culver City

    • Skilled Nursing Facility
    • Culver City, CA
    • NPI 1922350206

    Alta Hospitals System LLC, Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding Inc, MPT of Culver City PMH, L.P., MPT of Hollywood PMH, L.P., MPT of Van Nuys PMH, L.P., Prospect Medical Holdings Inc, Souther

    CMS ownership
  • Prospect Chartercare Home Health and Hospice, LLC
    • Home Health Agency
    • Providence, RI
    • NPI 1811402100

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare RWMC, LLC

    dba Roger Williams Medical Center

    • General Acute Care Hospital
    • Providence, RI
    • NPI 1013332014

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare RWMC, LLC

    dba Roger Williams Medical Center

    • Psychiatric Hospital Unit
    • Providence, RI
    • NPI 1477978476

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare Sjhsri, LLC

    dba Southern New England Rehabilitation Center

    • Rehabilitation Hospital Unit
    • North Providence, RI
    • NPI 1205251204

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare Sjhsri, LLC

    dba St. Joseph Health Center

    • Psychiatric Hospital Unit
    • North Providence, RI
    • NPI 1396160396

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare Sjhsri, LLC

    dba Our Lady of Fatima Hospital

    • General Acute Care Hospital
    • North Providence, RI
    • NPI 1871918870

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Waterbury Home Health, Inc.

    dba VNA Health at Home

    • Home Health Agency
    • Watertown, CT
    • NPI 1265880413

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Waterbury, Inc.
    • General Acute Care Hospital
    • Waterbury, CT
    • NPI 1477902641

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding Inc, Prospect Medical Holdings Inc

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 65

Affiliated clinicians 228

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 228

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1023010113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 S SEPULVEDA BLVD FL 9",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900346060",
            "telephone_number": "310-943-4500",
            "fax_number": "310-943-4501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6245 DE LONGPRE AVE",
            "city": "HOLLYWOOD",
            "state": "CA",
            "postal_code": "900288253",
            "telephone_number": "323-462-2271",
            "fax_number": "323-463-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA HEALTHCARE SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALTA HOSPITALS SYSTEM, LLC",
        "enumeration_date": "2005-06-02",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "ZILKOW",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "310-943-4500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "930000066",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP40135I",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHEILD",
            "identifier": "ZZZC9928Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP30135I",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSC30135I",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern California Hospital at Hollywood, at Van Nuys, at Culver City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern California Hospital at Hollywood, at Van Nuys, at Culver City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hollywood, CA

Sources for this page

Verify at the official NPI Registry.