NPIMap

Organization Active NPI

Northeast Community Clinic

Doing business as NECC - Gage Health Center

  • Federally Qualified Health Center (FQHC)
  • Huntington Park, CA
National Provider Identifier
1124460274
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHEAST COMMUNITY CLINIC
Doing business as
NECC - Gage Health Center
Practice address
2975 Zoe Ave
Huntington Park, CA 90255
Phone
(323) 771-8400
Fax
(323) 582-8500
NPI assigned
Jul 17, 2013
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Dr. Christopher LauNPI 1548365968
Title
Executive Director
Phone
(626) 457-6900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Pediatric Adolescent Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080A0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2975 Zoe Ave
Huntington Park, CA 90255

Mailing address

2550 W Main St Ste 301
Alhambra, CA 91801-7003
Phone (626) 457-6900

Other practice location 1

1414 S Grand Ave Ste 456
Los Angeles, CA 90015-3071
Phone (213) 745-6047

Other practice location 2

4455 W 117th St Ste 502
Hawthorne, CA 90250-2261
Phone (424) 236-4800

Other practice location 3

1414 S Grand Ave Ste 380
Los Angeles, CA 90015-3072
Phone (213) 743-9000

Other practice location 4

1403 Lomita Blvd Ste 103
Harbor City, CA 90710-2084
Phone (310) 784-1800

Other practice location 5

4129 Gage Ave
Bell, CA 90201-1128
Phone (323) 771-8400

Other names 1

  • NECC - Gage 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
O20040417000619 CA Part B Supplier - Clinic/Group Practice 5193710275 Receives reassigned benefits from 65 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bell, CA; Harbor City, CA; Hawthorne, CA; Huntington Park, CA; Los Angeles, CA; Wilmington, CA
O20140305000896 CA Part A Provider - Federally Qualified Health Center (FQHC) 5193710275 Practice locations: Huntington Park, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124460274. Details of each certification follow.

Federally qualified health center certification: CCN 751079

Legal name
NORTHEAST COMMUNITY CLINIC
Doing business as
NECC GAGE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 10, 2014
Last certification
Jun 10, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 27, 1971 in CA
Enrollment address
2975 Zoe Ave
Huntington Park, CA 90255

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory

Locations

1414 S Grand Ave
Ste 380
Los Angeles, CA 90015
Phone (213) 222-1300

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
Melissa M Aguilar Individual Corporate DirectorBoard Member Mar 2, 2006
Octavio Fierros Individual Corporate DirectorBoard Member Mar 10, 2021
Fumio Robert Nakahiro Individual Corporate DirectorBoard Member May 16, 1999
Irene Huerta Individual Corporate DirectorBoard Member Mar 21, 2018
Ali Mohammad Tweini Individual Corporate DirectorBoard Member Aug 11, 2021
Valery Marquez Perez Individual Corporate DirectorBoard Member Aug 11, 2021
Christopher T Lau Individual Corporate OfficerExecutive Director Aug 4, 1997
W-2 Managing EmployeeExecutive Director Aug 7, 1997
Ruby Y Medrano Individual Corporate DirectorBoard Member Jan 12, 2006
Mark Gonzalez Individual Corporate DirectorBoard Member Mar 11, 2010
Dalia M Jaramillo Individual Corporate DirectorBoard Member Jul 6, 2006
Monica Guardian Individual Corporate DirectorBoard Member Jun 1, 2016
Katrina Manning Individual Corporate DirectorBoard Member Mar 9, 2017
Patricia Sanders Individual Corporate DirectorBoard Member Jun 1, 2016

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1374019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1124460274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 W MAIN ST STE 301",
            "city": "ALHAMBRA",
            "state": "CA",
            "postal_code": "918017003",
            "telephone_number": "626-457-6900",
            "fax_number": "626-457-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 ZOE AVE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "90255",
            "telephone_number": "323-771-8400",
            "fax_number": "323-582-8500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1414 S Grand Ave Ste 456",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900153071",
            "country_code": "US",
            "telephone_number": "213-745-6047",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4455 W 117th St Ste 502",
            "address_purpose": "LOCATION",
            "city": "Hawthorne",
            "state": "CA",
            "postal_code": "902502261",
            "country_code": "US",
            "telephone_number": "424-236-4800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1414 S Grand Ave Ste 380",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900153072",
            "country_code": "US",
            "telephone_number": "213-743-9000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1403 Lomita Blvd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Harbor City",
            "state": "CA",
            "postal_code": "907102084",
            "country_code": "US",
            "telephone_number": "310-784-1800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4129 Gage Ave",
            "address_purpose": "LOCATION",
            "city": "Bell",
            "state": "CA",
            "postal_code": "902011128",
            "country_code": "US",
            "telephone_number": "323-771-8400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEAST COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-17",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "LAU",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "626-457-6900",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NECC - Gage Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NECC - Gage Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington Park, CA

Sources for this page

Verify at the official NPI Registry.