NPIMap

Organization Active NPI

St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1093278632
Registry record updated Feb 13, 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
1060 West Exposition Blvd.
Los Angeles, CA 90007
Phone
(323) 541-1600
Fax
(323) 541-1661
NPI assigned
Apr 10, 2019
Last updated
Feb 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Authorized official

Name
Maria Socorro Genie
Title
Executive Project Director
Phone
(323) 541-1600

Specialties & licenses 6

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

Addresses

Primary practice location

1060 West Exposition Blvd.
Los Angeles, CA 90007

Mailing address

808 W 58TH St
Los Angeles, CA 90037-3632
Phone (323) 541-1600

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
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Lynwood, CA; San Bernardino, CA; San Jacinto, CA; Compton, CA; Indio, CA
O20200121002305 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 1093278632. Details of each certification follow.

Federally qualified health center certification: CCN 921835

Legal name
ST. JOHN'S COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 31, 2020
Last certification
Jan 31, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 15, 1993 in CA
Enrollment address
1060 Exposition Blvd
Los Angeles, CA 90007-4242

Other NPIs on the same Medicare enrollment 27

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

View all 27

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

Locations

15715 S Atlantic Ave
Ste 2
Compton, CA 90221

2115 N Wilmington Ave
Ste A
Compton, CA 90222

1060 Exposition Blvd
Los Angeles, CA 90007
Phone 32354116002332

1910 Magnolia Ave
Los Angeles, CA 90007
Phone (213) 342-0100

326 W 23rd St
Los Angeles, CA 90007
Phone (323) 541-1400

4085 S Vermont Ave
Los Angeles, CA 90037
Phone (323) 541-1631

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
William E Dawe Individual Corporate DirectorBoard Treasurer Aug 10, 2002
Joanna Choi Individual Corporate DirectorBoard Member Jan 1, 2014
Elizabeth M Meisler Individual Corporate OfficerChief Financial Officer Sep 14, 2009
Lilia Garcia Individual Corporate DirectorBoard Chair Jul 5, 2002
James J Mangia Individual Corporate OfficerCeo Jan 10, 1993
W-2 Managing EmployeeCeo Jan 10, 1993
Ernesto Barahona Individual Corporate OfficerCoo Aug 12, 2016
Sushant Bandarpalle Individual Corporate OfficerCmo Jun 27, 2023
Martha Ortiz Individual Corporate DirectorBoard of Directors Member Jun 6, 2002

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1093278632",
    "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": "323-541-1600",
            "fax_number": "323-541-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 WEST EXPOSITION BLVD.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90007",
            "telephone_number": "323-541-1600",
            "fax_number": "323-541-1661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNS COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-10",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "GENIE",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "SOCORRO",
        "authorized_official_title_or_position": "EXECUTIVE PROJECT DIRECTOR",
        "authorized_official_telephone_number": "323-541-1600"
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "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": [],
    "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.