NPIMap

Organization Active NPI

Altamed Health Services Corp

Doing business as AltaMed Medical Group- Garden Grove,Harbor

  • Community Health Clinic/Center
  • Garden Grove, CA
National Provider Identifier
1083851992
Registry record updated Aug 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
ALTAMED HEALTH SERVICES CORP
Doing business as
AltaMed Medical Group- Garden Grove,Harbor
Practice address
12751 Harbor Blvd
Garden Grove, CA 92840-5800
Phone
(714) 636-7852
Fax
(714) 636-0928
NPI assigned
Jan 14, 2009
Last updated
Aug 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2019

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

Authorized official

Name
Robert U. Young, M.D.
Title
VP, Patient Financial Services
Phone
(323) 622-2429

Specialties & licenses 1

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

Addresses

Primary practice location

12751 Harbor Blvd
Garden Grove, CA 92840-5800

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (714) 636-7852

Other names 1

  • AltaMed Medical Group- Garden Grove,Harbor Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100416000720 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Garden Grove, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083851992. Details of each certification follow.

Federally qualified health center certification: CCN 551025

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-GARDEN GROVE, HARBOR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 2010
Last certification
Apr 16, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
12751 Harbor Blvd
Garden Grove, CA 92840-5800

Other NPIs with the same Medicare PAC ID 22

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

View all 22

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
05D1106763Altamed Medical Group-Garden Grove Harbor12751 Harbor Blvd, Garden Grove, CA 92840Certificate of waiverOct 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Altamed Senior Clinic117 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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 Grimaldo Individual Corporate DirectorBoard Member Oct 29, 2013
Jose Avalos Individual Corporate DirectorBoard Chair Jun 28, 2018
Adolfo O Chanez Individual Corporate DirectorBoard Member Feb 25, 2016
Castulo de la Rocha Individual Corporate OfficerPres/Ceo Mar 1, 1997
Marc Victor Individual Corporate DirectorTreasurer Oct 26, 2017
Ricardo Robles Individual Corporate DirectorVice Chair Jan 22, 2015
Victor Olmos Individual Corporate DirectorBoard Member Oct 23, 2020
Joseph Gomez Individual Corporate DirectorBoard Member Sep 6, 2019
Jose Ubaldo Esparza Individual Corporate OfficerEvp. Finance and Cfo Jan 20, 1994
Robert Young Individual W-2 Managing EmployeeVice President, PFS Jan 6, 2012
Nadia Paola Alvarez Individual Corporate DirectorBoard Member Sep 6, 2019
Lucy Maria Herrera Individual Corporate DirectorSecretary Nov 5, 2019

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1083851992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 CAMFIELD AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900401501",
            "telephone_number": "714-636-7852",
            "fax_number": "714-636-0928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12751 HARBOR BLVD",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928405800",
            "telephone_number": "714-636-7852",
            "fax_number": "714-636-0928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-14",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "U.",
        "authorized_official_title_or_position": "VP, PATIENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "323-622-2429",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AltaMed Medical Group- Garden Grove,Harbor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AltaMed Medical Group- Garden Grove,Harbor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.