NPIMap

Organization Active NPI

Southland Integrated Services, Inc.

Doing business as Integrated Community Services - Santa Ana

  • Federally Qualified Health Center (FQHC)
  • Santa Ana, CA
National Provider Identifier
1134636889
Registry record updated Feb 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHLAND INTEGRATED SERVICES, INC.
Doing business as
Integrated Community Services - Santa Ana
Practice address
1200 N Main St Ste 300
Santa Ana, CA 92701-3625
Phone
(714) 480-7629
NPI assigned
Jan 3, 2018
Last updated
Feb 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2019

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

Authorized official

Name
Tricia Thao Nguyen, M.P.H.
Title
Chief Executive Officer
Phone
(714) 620-7007

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1200 N Main St Ste 300
Santa Ana, CA 92701-3625

Mailing address

1200 N Main St Ste 200
Santa Ana, CA 92701-3640
Phone (714) 480-7629

Other names 1

  • Integrated Community Services - Santa Ana Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134636889. Details of each certification follow.

  • CCN 921057 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921057

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
INTEGRATED COMMUNITY SERVICES - SANTA ANA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 26, 2018
Last certification
Mar 26, 2018
Ownership / control type
For profit – corporation
Facility address
1200 North Main Street, Suite 300
Santa Ana, CA 92701

National Provider Directory

National Provider Directory

Locations

1200 N Main St
#200
Santa Ana, CA 92701
Phone (714) 480-4652

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GFCABD

Practitioners & affiliated clinicians

Practitioners 11

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": "1514937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551225600000",
    "number": "1134636889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N MAIN ST STE 200",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927013640",
            "telephone_number": "714-480-7629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N MAIN ST STE 300",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927013625",
            "telephone_number": "714-480-7629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND INTEGRATED SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-03",
        "last_updated": "2019-02-27",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_middle_name": "THAO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "714-620-7007",
        "authorized_official_credential": "M.P.H."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Community Services - Santa Ana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.