NPIMap

Organization Active NPI

Share Our Selves Corporation

Doing business as SOS Children & Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Newport Beach, CA
National Provider Identifier
1033514708
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHARE OUR SELVES CORPORATION
Doing business as
SOS Children & Family Health Center
Practice address
307 Placentia Ave Ste 107
Newport Beach, CA 92663-3307
Phone
(949) 270-2100
Fax
(949) 650-4458
NPI assigned
Oct 23, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Authorized official

Name
Christy Ward
Title
Ceo
Phone
(949) 536-3927

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

307 Placentia Ave Ste 107
Newport Beach, CA 92663-3307

Mailing address

PO Box 10159
Costa Mesa, CA 92627-0050
Phone (949) 270-2100

Other names 1

  • SOS Children & Family Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110825000722 CA Part B Supplier - Clinic/Group Practice 4789854993 Receives reassigned benefits from 42 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Costa Mesa, CA; Mission Viejo, CA; Newport Beach, CA; Santa Ana, CA; Anaheim, CA
O20160422001721 CA Part A Provider - Federally Qualified Health Center (FQHC) 4789854993 Practice locations: Newport Beach, CA

Federally qualified health center certification: CCN 751856

Legal name
SHARE OUR SELVES CORPORATION
Doing business as
SHARE OUR SELVES CHILDREN AND FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 26, 2016
Last certification
Feb 26, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
307 Placentia Ave
Ste 107
Newport Beach, CA 92663-3307

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Locations

1500 Superior Ave
CA 92627

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Kathleen a Bruski Individual Operational/Managerial ControlCredentialing & Privileging Mana Feb 1, 2016
Ernest W Klatte Individual Corporate DirectorSos, Board of Directors Feb 16, 2016
Share Our Selves Corporation Organization, Newport Beach, CA Corporation, Non-profit Other Feb 1, 2016 100%
Gabriela Robles Individual Corporate OfficerMember,Sos Board of Directors Feb 1, 2016
Corporate DirectorMember,Sos Board of Directors Feb 16, 2016
OtherMember,Sos Board of Directors Feb 1, 2016
Susan Epstein Individual Corporate DirectorMember,Sos Board of Directors Feb 16, 2016
Sergey Sergeyev Individual Corporate OfficerCfo Feb 1, 2016
Karen L McGlinn Individual Corporate OfficerCeo Jan 1, 1993 100%
OtherCeo Feb 1, 2016
Gwyn P Parry Individual Corporate DirectorSos,Board of Directors - Chairma Feb 16, 2016
Christy Ward Individual Corporate DirectorChief Executive Officer Sep 3, 2019

Owners & managing parties with NPI records 7

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
Sos-El Sol Wellness CenterSanta Ana, CA, CCN 751858 Federally qualified health center Other (100%) Feb 2, 2016
Share OurselvesCosta Mesa, CA, CCN A01907 Federally qualified health center Other (100%) Sep 6, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613952000000",
    "number": "1033514708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10159",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926270050",
            "telephone_number": "949-270-2100",
            "fax_number": "949-515-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 PLACENTIA AVE STE 107",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633307",
            "telephone_number": "949-270-2100",
            "fax_number": "949-650-4458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHARE OUR SELVES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-23",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-536-3927"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOS Children & Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.