NPIMap

Organization Active NPI

Beverly Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1144791500
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BEVERLY COMMUNITY CLINIC
Practice address
2252 Beverly Blvd Ste 103
Los Angeles, CA 90057-2246
Phone
(213) 674-7424
NPI assigned
Dec 11, 2018
Last updated
Mar 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Authorized official

Name
Dr. John Burns, MDNPI 1407921737
Title
Chief Medical Officer
Phone
(213) 674-7424

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

2252 Beverly Blvd Ste 103
Los Angeles, CA 90057-2246

Mailing address

2252 Beverly Blvd Ste 103
Los Angeles, CA 90057-2246
Phone (213) 674-7424

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20210202000693 CA Part B Supplier - Clinic/Group Practice 7810301926 Receives reassigned benefits from 11 practitioners
Practice locations: Los Angeles, CA
O20240528001549 CA Part A Provider - Federally Qualified Health Center (FQHC) 7810301926 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144791500. Details of each certification follow.

Federally qualified health center certification: CCN A01190

Legal name
BEVERLY COMMUNITY CLINIC
Doing business as
SAME
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 2, 2024
Last certification
May 2, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 2016 in CA
Enrollment address
2252 Beverly Blvd
Ste 103
Los Angeles, CA 90057-2246

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
05D2151800Beverly Community Clinic2252 Beverly Blvd #103, Los Angeles, CA 90057Certificate of waiverJul 26, 2028

National Provider Directory

National Provider Directory

Locations

3755 Beverly Blvd
Ste 200
Los Angeles, CA 90004
Phone (213) 370-1050

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
John S Burns Individual OtherMedical Doctor Nov 1, 2023
Ana Laura Mejia Individual Corporate DirectorBoard Director Nov 1, 2023
W-2 Managing EmployeeBoard Director Nov 1, 2023
Narine Minasyan Individual Corporate DirectorBoard Director Nov 1, 2023
W-2 Managing EmployeeBoard Director Nov 1, 2023
Kristine Galstyan Individual Corporate DirectorBoard Director Nov 1, 2023
W-2 Managing EmployeeBoard Director Nov 1, 2023
Abel Lomeli Individual Corporate DirectorBoard Director Nov 1, 2023
W-2 Managing EmployeeBoard Director Nov 1, 2023
Aram Ghazaryan Individual OtherTreasurer Nov 1, 2023
Jhairo Ronald Echevarria Individual OtherChairman Nov 3, 2023
Jacob N Flores Individual OtherMedical Doctor Nov 1, 2023
Beverly Community Clinic Organization, Los Angeles, CA Non-profit Operational/Managerial Control Nov 1, 2023
Other Nov 1, 2023
Cynthia Perez Individual OtherVice Chairman Nov 1, 2023
Blanca Oralia Roman Individual Corporate DirectorBoard Director Nov 1, 2023
W-2 Managing EmployeeBoard Director Nov 1, 2023
Yeghishe Amirkhanyan Individual OtherSecretary Nov 1, 2023
Inkara Daniel Individual Corporate OfficerCeo Nov 1, 2023
Corporate DirectorCeo Nov 1, 2023

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 12

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": "1544486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1144791500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2252 BEVERLY BLVD STE 103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572246",
            "telephone_number": "213-674-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2252 BEVERLY BLVD STE 103",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572246",
            "telephone_number": "213-674-7424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-11",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "BURNS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "213-674-7424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "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": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.