NPIMap

Organization Active NPI

Hurtt Family Health Clinic Inc.

  • Federally Qualified Health Center (FQHC)
  • Anaheim, CA
National Provider Identifier
1144760943
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HURTT FAMILY HEALTH CLINIC INC.
Practice address
947 S Anaheim Blvd Ste 260
Anaheim, CA 92805-5591
Phone
(714) 247-0300
Fax
(714) 259-1598
NPI assigned
Feb 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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

Authorized official

Name
Becky Carter
Title
Executive Director
Phone
(714) 247-8044

Specialties & licenses 1

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

Addresses

Primary practice location

947 S Anaheim Blvd Ste 260
Anaheim, CA 92805-5591

Mailing address

1 Hope Dr
Tustin, CA 92782-0221
Phone (714) 247-0300

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110203000426 CA Part B Supplier - Clinic/Group Practice 4183764814 Receives reassigned benefits from 15 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anaheim, CA; Tustin, CA
O20230106000600 CA Part A Provider - Federally Qualified Health Center (FQHC) 4183764814 Practice locations: Anaheim, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144760943. Details of each certification follow.

Federally qualified health center certification: CCN A01140

Legal name
HURTT FAMILY HEALTH CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 4, 2023
Last certification
Jan 4, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
947 S Anaheim Blvd
Ste 260
Anaheim, CA 92805-5591

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 6

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

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
05D2136679Hurtt Family Health Clinic Inc947 S Anaheim Blvd Ste 260, Anaheim, CA 92805Certificate of waiverDec 3, 2026

National Provider Directory

National Provider Directory
Tax ID family
Hurtt Family Health Clinic Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Courtnee Novales Individual Operational/Managerial ControlDirector of Nursing Sep 6, 2022
Warren T Yamashita Individual Operational/Managerial ControlInterim Medical Director Nov 16, 2022
Larry Gwilt Individual 5% Or Greater Direct Ownership InterestChief Financial Officer May 16, 2019
Corporate OfficerChief Financial Officer May 16, 2019
Joe Gonzalez Individual 5% Or Greater Direct Ownership InterestInterim Executive Director Sep 16, 2022
Corporate DirectorInterim Executive Director Sep 16, 2022 100%
Operational/Managerial ControlInterim Executive Director Sep 16, 2022 100%

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 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": "1488240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574726400000",
    "number": "1144760943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOPE DR",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927820221",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "947 S ANAHEIM BLVD STE 260",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928055591",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HURTT FAMILY HEALTH CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-28",
        "last_updated": "2019-11-26",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "714-247-8044"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.