NPIMap

Organization Active NPI

Greater Fresno Health Organization, Inc.

Doing business as Cedar University Clinic

  • Community Health Clinic/Center
  • Fresno, CA
National Provider Identifier
1033627179
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
GREATER FRESNO HEALTH ORGANIZATION, INC.
Doing business as
Cedar University Clinic
Practice address
4770 N Cedar Ave
Fresno, CA 93726-1065
Phone
(559) 860-4900
Fax
(559) 255-7906
NPI assigned
Jan 10, 2018
Last updated
Apr 29, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
GREATER FRESNO HEALTH ORGANIZATION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

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

Authorized official

Name
Bla Mouanoutoua
Title
Ceo
Phone
(559) 255-6476

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

4770 N Cedar Ave
Fresno, CA 93726-1065

Mailing address

4770 N Cedar Ave
Fresno, CA 93726-1065
Phone (559) 860-4900

Other names 1

  • Cedar University Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190329001866 CA Part A Provider - Federally Qualified Health Center (FQHC) 2860523990 Practice locations: Fresno, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033627179. Details of each certification follow.

Federally qualified health center certification: CCN 921142

Legal name
GREATER FRESNO HEALTH ORGANIZATION INC
Doing business as
CEDAR UNIVERSITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 12, 2019
Last certification
Apr 12, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 1992 in CA
Enrollment address
4770 N Cedar Ave
Fresno, CA 93726-1065

Other NPIs with the same Medicare PAC ID 2

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

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
05D2147376Cedar University Clinic4770 N Cedar Ave, Fresno, CA 93726Provider-performed microscopyApr 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kings Winery Medical3 organizations share this tax ID, including this one
Part of
Kings Winery Medical

Other organizations with this tax ID 2

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

Locations

4011 N Marks Ave
Fresno, CA 93722
Phone (559) 860-4925

4770 N Cedar Ave
Fresno, CA 93726
Phone (559) 860-4900

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Howard Thao Individual Corporate DirectorBoard Member Sep 4, 2018 11%
Paul Yang Individual Corporate OfficerCfo Sep 4, 2018 33%
Lelick Vu Individual Corporate DirectorBoard MBR Sep 4, 2018 12%
Lexi Namsa Individual Corporate DirectorBoard Member Sep 4, 2018 11%
Lorenzo Thomas Individual Corporate DirectorBoard Member Sep 4, 2018 11%
Greater Fresno Health Organization Inc Organization, Fresno, CA Corporation, Non-profit Operational/Managerial Control Sep 4, 2018 100%
Trina Toepfer Individual Corporate DirectorBoard Member Sep 4, 2018 11%
Thomas Her Individual Corporate DirectorBoard Member Sep 4, 2018 11%
Bla Mouanoutoua Individual Corporate OfficerCoo Sep 4, 2018 33%
Bobby Bliatout Individual Corporate OfficerCeo Sep 4, 2018 34%
Operational/Managerial ControlCeo Sep 4, 2018 100%
Alfonso Sanchez Individual Corporate DirectorBoard Member Sep 4, 2018 11%
Lia Vangyi Individual Corporate DirectorBoard Member Sep 4, 2018 11%
Susie Prop Individual Corporate DirectorBoard Member Sep 4, 2018 11%

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 1

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

FacilityTypeRoleSince
North Marks Medical ClinicFresno, CA, CCN 751091 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2014

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1515542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714348800000",
    "number": "1033627179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 N CEDAR AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937261065",
            "telephone_number": "559-860-4900",
            "fax_number": "559-255-7906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 N CEDAR AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937261065",
            "telephone_number": "559-860-4900",
            "fax_number": "559-255-7906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER FRESNO HEALTH ORGANIZATION, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GREATER FRESNO HEALTH ORGANIZATION, INC.",
        "enumeration_date": "2018-01-10",
        "last_updated": "2024-04-29",
        "certification_date": "2023-07-25",
        "status": "A",
        "authorized_official_last_name": "MOUANOUTOUA",
        "authorized_official_first_name": "BLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-255-6476"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar University Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.