NPIMap

Organization Active NPI

Share Our Selves Corporation

Doing business as Share Our Selves Pharmacy

  • Federally Qualified Health Center (FQHC)
  • Costa Mesa, CA
National Provider Identifier
1144717778
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHARE OUR SELVES CORPORATION
Doing business as
Share Our Selves Pharmacy
Practice address
1550 Superior Ave
Costa Mesa, CA 92627-3653
Phone
(949) 270-2135
NPI assigned
Apr 19, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Authorized official

Name
Christy Ward
Title
Ceo
Phone
(949) 536-3927

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1550 Superior Ave
Costa Mesa, CA 92627-3653

Mailing address

PO Box 10159
Costa Mesa, CA 92627-0050
Phone (949) 270-2135

Other identifiers 1

IdentifierTypeStateIssuer
55931OtherCARETAIL PHARMACY

Other names 1

  • Share Our Selves Pharmacy Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210408000758 CA Part B Supplier - Pharmacy 4789854993 Practice locations: Costa Mesa, CA
O20210511001207 CA Part B Supplier - Mass Immunization (Roster Biller Only) 4789854993 Practice locations: Costa Mesa, CA

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Share Our Selves Corporation10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Share Our Selves Children and Family Health CenterNewport Beach, CA, CCN 751856 Federally qualified health center Other (100%) Feb 1, 2016
Sos-El Sol Wellness CenterSanta Ana, CA, CCN 751858 Federally qualified health center Other (100%) Feb 2, 2016
Share OurselvesCosta Mesa, CA, CCN A01907 Federally qualified health center Other (100%) Sep 6, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1144717778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10159",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926270050",
            "telephone_number": "949-270-2135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 SUPERIOR AVE",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273653",
            "telephone_number": "949-270-2135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHARE OUR SELVES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-19",
        "last_updated": "2024-10-15",
        "certification_date": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-536-3927"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RETAIL PHARMACY",
            "identifier": "55931",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Share Our Selves Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.