NPIMap

Organization Active NPI

Pomona Community Health Center

  • Community Health Clinic/Center
  • Ontario, CA
National Provider Identifier
1154788560
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
POMONA COMMUNITY HEALTH CENTER
Practice address
1556 S Sultana Ave
Ontario, CA 91761-4238
Phone
(909) 984-7384
Fax
(909) 984-7268
NPI assigned
Jan 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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

Authorized official

Name
Ellen R Silver, NP
Title
Ceo
Phone
(909) 630-7939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

1556 S Sultana Ave
Ontario, CA 91761-4238

Mailing address

1450 E Holt Ave
Pomona, CA 91767-5822
Phone (909) 630-7927

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150723006703 CA Part B Supplier - Clinic/Group Practice 5890940605 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pomona, CA; Ontario, CA
O20160331000573 CA Part A Provider - Federally Qualified Health Center (FQHC) 5890940605 Practice locations: Ontario, CA

Federally qualified health center certification: CCN 751845

Legal name
POMONA COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 17, 2016
Last certification
Mar 17, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 2005 in CA
Enrollment address
1556 S Sultana Ave
Ontario, CA 91761-4238

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Parktree Community Health Center20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

1450 E Holt Ave
Pomona, CA 91767

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
David M Kadar Individual Corporate OfficerChief Executive Officer Aug 15, 2016
W-2 Managing EmployeeChief Executive Officer Aug 15, 2016
Alfonso Aguilera Individual Corporate OfficerChief Financial Officer Jan 2, 2014
W-2 Managing EmployeeChief Financial Officer Jan 2, 2014
Elvia Sanchez Individual Corporate OfficerChief Operations Officer May 9, 2016
W-2 Managing EmployeeChief Operations Officer May 9, 2016
Peggy Sanchez Individual Corporate DirectorBoard Treasurer Feb 1, 2016
James Alig Individual Corporate DirectorBoard Director Jan 1, 2014
Abigail Pascua Individual Corporate DirectorBoard Member Apr 1, 2022
Ava Phillips Individual Corporate DirectorBoard Secretary Apr 1, 2022
Elvia Rivas Individual Corporate DirectorBoard Member Feb 1, 2016
Michael Nelson Individual Corporate DirectorBoard Member Feb 1, 2016
Jonathan Berends Individual Corporate Director Apr 1, 2022
Gwendolyn Keys Individual Corporate DirectorBoard Member Feb 1, 2016

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1154788560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 E HOLT AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675822",
            "telephone_number": "909-630-7927",
            "fax_number": "909-620-6719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1556 S SULTANA AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917614238",
            "telephone_number": "909-984-7384",
            "fax_number": "909-984-7268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POMONA COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "SILVER",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-630-7939",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ontario, CA

Sources for this page

Verify at the official NPI Registry.