NPIMap

Organization Active NPI

T H E Clinic Inc

  • Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1023287679
Registry record updated May 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
960001020 Issued in CA
Legal business name
T H E CLINIC INC
Doing business as
T.H.E. Clinic, Inc.
Practice address
3834 S. Western Avenue
Los Angeles, CA 90062
Phone
(323) 730-1920
Fax
(323) 730-9777
NPI assigned
Feb 28, 2008
Last updated
May 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2013

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

Authorized official

Name
Ms. Rise K. Phillips, M.P.H., M.B.A.
Title
President/Ceo
Phone
(323) 730-1920

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 960001020 CA Primary

Addresses

Primary practice location

3834 S. Western Avenue
Los Angeles, CA 90062

Mailing address

3834 S. Western Avenue
Los Angeles, CA 90062
Phone (323) 730-1920

Other names 1

  • T.H.E. Clinic, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA6 enrollments

Enrollment records 6

Enrollment IDStateProvider typePAC IDDetails
O20090414000765 CA Part A Provider - Federally Qualified Health Center (FQHC) 5294882924 Practice locations: Los Angeles, CA
O20140508000570 CA Part B Supplier - Clinic/Group Practice 5294882924 Receives reassigned benefits from 26 practitioners
Practice locations: Los Angeles, CA
O20161114001494 CA Part A Provider - Federally Qualified Health Center (FQHC) 5294882924 Practice locations: Lennox, CA
O20161114002072 CA Part A Provider - Federally Qualified Health Center (FQHC) 5294882924 Practice locations: Los Angeles, CA
O20161114002188 CA Part A Provider - Federally Qualified Health Center (FQHC) 5294882924 Practice locations: Los Angeles, CA
O20161114002256 CA Part A Provider - Federally Qualified Health Center (FQHC) 5294882924 Practice locations: Inglewood, CA

NPI to CCN mapping 5

The Medicare certification numbers (CCNs) connected to NPI 1023287679. Details of each certification follow.

Federally qualified health center certification: CCN 051196

Legal name
T H E CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 18, 2009
Last certification
Aug 18, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1974 in CA
Enrollment address
3834 S Western Ave
Los Angeles, CA 90062-1104

Federally qualified health center certification: CCN 751929

Legal name
T H E CLINIC INC
Doing business as
T.H.E. HEALTH AND WELLNESS CENTERS AT LENNOX
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 4, 2016
Last certification
Nov 4, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1974 in CA
Enrollment address
10223 Firmona Ave
Lennox, CA 90304-1421

Federally qualified health center certification: CCN 751928

Legal name
T H E CLINIC INC
Doing business as
T.H.E. HEALTH AND WELLNESS CENTERS AT LA BREA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 7, 2016
Last certification
Nov 7, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1974 in CA
Enrollment address
3721 S la Brea Ave
Los Angeles, CA 90016-5309

Federally qualified health center certification: CCN 751927

Legal name
T H E CLINIC INC
Doing business as
T.H.E. HEALTH AND WELLNESS CENTERS AT CRENSHAW
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 7, 2016
Last certification
Nov 7, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1974 in CA
Enrollment address
3206 W 50TH St
Los Angeles, CA 90043-4872

Federally qualified health center certification: CCN 751926

Legal name
T H E CLINIC INC
Doing business as
T.H.E. CLINIC, INC. AT HAWTHORNE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 7, 2016
Last certification
Nov 7, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 15, 1974 in CA
Enrollment address
10321 Hawthorne Blvd
Inglewood, CA 90304-1500

National Provider Directory

National Provider Directory

Locations

10321 Hawthorne Blvd
Inglewood, CA 90304
Phone (323) 730-1920

3206 W 50th St
Los Angeles, CA 90043
Phone (323) 730-1920

3721 S La Brea Ave
Los Angeles, CA 90016
Phone (323) 730-1920

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Ronald Braden Individual Corporate Director Jan 1, 2018
Tatyana Klochko Individual Corporate OfficerCfo Apr 18, 2011
W-2 Managing EmployeeCfo Apr 18, 2011
Corporate Officer Apr 18, 2011
W-2 Managing Employee Apr 18, 2011
Richard Hamilton Individual Corporate Director Jan 1, 2018
Deborah Miller Individual Corporate Director Jan 1, 2018
Heather McCullough Individual Corporate Director Jan 1, 2018
Corporate Director Jan 1, 2016
Mary Alejo Individual Corporate Director Jan 1, 2018
Damone Thomas Individual Corporate Director Feb 1, 2015
Caitlyn Kenna Carrera Individual Corporate Director Jan 1, 2015
Cindy Aguilar Individual Corporate Director Jan 1, 2014
Joann Isken Individual Corporate Officer Jan 1, 2012
Corporate Director Jan 1, 2012
T H E Clinic Inc Organization, Lennox, CA Non-profit Operational/Managerial Control Apr 18, 2011
Denise Eaton-May Individual Corporate Director Jan 1, 2015
Patick Harris Individual Corporate Director Jan 1, 2012
Yajaira Vivas Individual Corporate Director Jan 1, 2015

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1204156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368748800000",
    "number": "1023287679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3834 S. WESTERN AVENUE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90062",
            "telephone_number": "323-730-1920",
            "fax_number": "323-730-9777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3834 S. WESTERN AVENUE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90062",
            "telephone_number": "323-730-1920",
            "fax_number": "323-730-9777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T H E CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-28",
        "last_updated": "2013-05-17",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "RISE",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "323-730-1920",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.P.H., M.B.A."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "960001020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "T.H.E. Clinic, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.