NPIMap

Organization Active NPI

Heritage Clinic and the Community Assistance Program for Seniors

Doing business as Heritage Clinic Lancaster

  • Clinical Psychologist
  • Lancaster, CA
National Provider Identifier
1023234747
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS
Doing business as
Heritage Clinic Lancaster
Practice address
43807 10TH St W Ste D
Lancaster, CA 93534-4805
Phone
(661) 575-9365
Fax
(661) 575-9502
NPI assigned
Apr 18, 2007
Last updated
Feb 17, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Authorized official

Name
Mr. Vatche Kelartinian, MBA
Title
Cfo
Phone
(626) 577-8480

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY19717 CA
Clinical Psychologist 103TC0700X NU Primary
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

43807 10TH St W Ste D
Lancaster, CA 93534-4805

Mailing address

447 N El Molino Ave
Pasadena, CA 91101-1403
Phone (626) 577-8480

Other names 1

  • Heritage Clinic Lancaster Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040412001075 CA Part B Supplier - Clinic/Group Practice 9032005798 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pasadena, CA; West Covina, CA; Los Angeles, CA; Long Beach, CA; Lancaster, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Heritage Clinic and the Community Assistance Program for Seniors4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1023234747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 N EL MOLINO AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911011403",
            "telephone_number": "626-577-8480",
            "fax_number": "626-577-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43807 10TH ST W STE D",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935344805",
            "telephone_number": "661-575-9365",
            "fax_number": "661-575-9502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "KELARTINIAN",
        "authorized_official_first_name": "VATCHE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "626-577-8480",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY19717",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Clinic Lancaster",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.