NPIMap

Organization Active NPI

University of California Irvine

  • Psychiatric Hospital Unit
  • Orange, CA
National Provider Identifier
1154500510
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
UNIVERSITY OF CALIFORNIA IRVINE
Practice address
101 The City Dr S
Orange, CA 92868-3201
Phone
(714) 456-7295
Fax
(714) 456-7339
NPI assigned
Nov 1, 2007
Organization subpart
Yes
Parent organization
UCI MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

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

Authorized official

Name
Gina Churchill
Title
Reimbursement Director
Phone
(714) 509-6266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

101 The City Dr S
Orange, CA 92868-3201

Mailing address

1500 S Douglass Rd #100, RT 183
Anaheim, CA 92806-6912
Phone (714) 509-6266

Other identifiers 1

IdentifierTypeStateIssuer
HSM30348GMedicaidCA

Other names 1

  • UCI MEDICAL CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120328000645 CA Part A Provider - Hospital 5395658181 Practice locations: Orange, CA

Hospital certification: CCN 05S348

Legal name
UNIVERSITY OF CALIFORNIA IRVINE
Doing business as
UNIVERSITY OF CALIFORNIA IRVINE MEDICAL CENTER
Organization structure
OtherNon-profit
Incorporated
Jun 18, 1868 in CA
Enrollment address
101 The City Dr S
Orange, CA 92868-3201
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory
Tax ID family
Regents of the University of California42 organizations share this tax ID, including this one
Part of
Regents of the University of California

Other organizations with this tax ID 41

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

View all 41

Locations

1500 S Douglass Rd
Ste 100
Anaheim, CA 92806

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/30912/brand/1/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Randolph Peseverance Siwabessy Individual Corporate DirectorChief Financial Officer Jul 1, 2021 100%
W-2 Managing EmployeeChief Financial Officer Jul 1, 2021 100%
Operational/Managerial ControlChief Financial Officer Jul 1, 2021 100%
Gina L Churchill Individual W-2 Managing EmployeeReimbursement Director Jul 1, 2015 5%
University of California Irvine Organization, Orange, CA 5% Or Greater Direct Ownership Interest Nov 19, 2007
Chad Thurman Lefteris Individual Corporate OfficerChief Executive Officer Apr 2, 2020
Corporate DirectorChief Executive Officer Apr 2, 2020 100%
W-2 Managing EmployeeChief Executive Officer Apr 2, 2020 100%
Operational/Managerial ControlChief Executive Officer Apr 2, 2020 100%
Howard Aaron Gillman Individual Corporate OfficerChancellor Jul 1, 2016 100%
Operational/Managerial ControlChancellor Jul 1, 2016 100%

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Uci HealthOrange, CA, CCN 050348 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 1974
Aug 1, 1974
University of California Irvine Medical CenterOrange, CA, CCN 05T348 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Uci Health - Los AlamitosLos Alamitos, CA, CCN 050551 Hospital Operational/Managerial Control (100%) Mar 26, 2024
Uci Health - LakewoodLakewood, CA, CCN 050581 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 26, 2024
Mar 26, 2024
Uci Family Health Center Santa AnaSanta Ana, CA, CCN 051893 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 1, 1993
Uci Family Health Center-Santa AnaSanta Ana, CA, CCN 551965 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 20, 2004
Mar 20, 2004

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1193875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572825600000",
    "number": "1154500510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S DOUGLASS RD #100, RT 183",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928066912",
            "telephone_number": "714-509-6266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 THE CITY DR S",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683201",
            "telephone_number": "714-456-7295",
            "fax_number": "714-456-7339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF CALIFORNIA IRVINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UCI MEDICAL CENTER",
        "enumeration_date": "2007-11-01",
        "last_updated": "2019-11-04",
        "status": "A",
        "authorized_official_last_name": "CHURCHILL",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "REIMBURSEMENT DIRECTOR",
        "authorized_official_telephone_number": "714-509-6266"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSM30348G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCI MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCI MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.