NPIMap

Organization Active NPI

St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1073653630
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST. JOHNS COMMUNITY HEALTH
Practice address
1910 Magnolia Ave
Los Angeles, CA 90007-1220
Phone
(213) 749-0947
Fax
(213) 749-7354
NPI assigned
Feb 6, 2007
Last updated
Feb 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Authorized official

Name
James J Mangia
Title
Chief Executive Officer
Phone
(323) 541-1660

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Community Health Clinic/Center 261QC1500X 960000214 CA
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Contractor 171W00000X
Case Manager/Care Coordinator 171M00000X
Supports Brokerage Agency 251X00000X

Addresses

Primary practice location

1910 Magnolia Ave
Los Angeles, CA 90007-1220

Mailing address

808 W 58TH St
Los Angeles, CA 90037-3632
Phone (323) 541-1660

Other identifiers 2

IdentifierTypeStateIssuer
FHC 70764FMedicaidCA
1073653630MedicaidCA

Other names 1

  • St. John's Well Child and Family Center, Inc. Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040722001434 CA Part B Supplier - Clinic/Group Practice 2961482690 Receives reassigned benefits from 440 practitioners
27 other NPIs on this enrollment
Practice locations: Los Angeles, CA; Lynwood, CA; San Bernardino, CA; San Jacinto, CA; Compton, CA; Indio, CA
O20051201000503 CA Part A Provider - Federally Qualified Health Center (FQHC) 2961482690 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073653630. Details of each certification follow.

Federally qualified health center certification: CCN 051042

Legal name
ST. JOHN'S COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 2, 2006
Last certification
Feb 2, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 15, 1993 in CA
Enrollment address
1910 Magnolia Ave
Ste 101
Los Angeles, CA 90007-1220

Other NPIs on the same Medicare enrollment 27

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

View all 27

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
05D1014132St John's Community Health - Magnolia1910 S Magnolia Ave Ste 101, Los Angeles, CA 90007Certificate of waiverMar 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
St Johns Well Child and Fam36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Maria Benel Corazon G SE Individual Corporate DirectorBoard Member Jul 5, 2010
William E Dawe Individual Corporate DirectorBoard Treasurer Aug 10, 2002
Tim Neiman Individual Corporate DirectorBoard Member Mar 12, 2006
Joanna Choi Individual Corporate DirectorBoard Member Jan 1, 2014
Elizabeth M Meisler Individual Corporate OfficerCfo Sep 14, 2009
Lilia Garcia Individual Corporate DirectorBoard Chair Jul 5, 2002
James J Mangia Individual Corporate OfficerCeo Jan 10, 1993
W-2 Managing Employee Jan 10, 1993
Helen M Duplessis Individual Corporate DirectorBoard Member Jan 1, 2014
Lawrence R Young Individual Corporate DirectorBoard Member Jan 5, 2010
Ernesto Barahona Individual Corporate OfficerCoo Aug 12, 2016
Sushant Bandarpalle Individual Corporate OfficerCmo Jun 27, 2023
W-2 Managing EmployeeCmo Jun 27, 2023
Martha Ortiz Individual Corporate DirectorBoard of Directors Member Jun 6, 2002

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 449

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 449

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1073653630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1660",
            "fax_number": "323-541-1665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 MAGNOLIA AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900071220",
            "telephone_number": "213-749-0947",
            "fax_number": "213-749-7354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNS COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "MANGIA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "323-541-1660"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "960000214",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC 70764F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073653630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John's Well Child and Family Center, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.