NPIMap

Organization Active NPI

Pomona Community Health Center

Doing business as Parktree Community Health Center

  • Community Health Clinic/Center
  • Ontario, CA
National Provider Identifier
1154860963
Registry record updated Feb 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
POMONA COMMUNITY HEALTH CENTER
Doing business as
Parktree Community Health Center
Practice address
2680 E Riverside Dr
Ontario, CA 91761-7307
Phone
(909) 630-7927
Fax
(909) 620-6719
NPI assigned
Feb 14, 2017
Last updated
Feb 14, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2017

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

Authorized official

Name
Ellen R Silver, NP
Title
Chief Executive Officer
Phone
(909) 630-7939

Specialties & licenses 1

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

Addresses

Primary practice location

2680 E Riverside Dr
Ontario, CA 91761-7307

Mailing address

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

Other names 1

  • Parktree Community Health Center Doing business as

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
O20170803003923 CA Part A Provider - Federally Qualified Health Center (FQHC) 5890940605 Practice locations: Ontario, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154860963. Details of each certification follow.

Federally qualified health center certification: CCN 751985

Legal name
POMONA COMMUNITY HEALTH CENTER
Doing business as
PARKTREE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 20, 2017
Last certification
Jun 20, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 13, 2005 in CA
Enrollment address
2680 E Riverside Dr
Ontario, CA 91761-7307

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.

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
05D2144093Pomona Community Health Center2680 E. Riverside Dr., Ontario, CA 91761Certificate of waiverMay 5, 2027

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

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 Jan 1, 2020
W-2 Managing EmployeeChief Executive Officer Jan 1, 2020
Alfonso Aguilera Individual Corporate OfficerChief Financial Officer Jan 2, 2014
Corporate DirectorChief Financial Officer Jan 2, 2014
W-2 Managing EmployeeChief Financial Officer Jan 2, 2014
Elvia Sanchez Individual Corporate OfficerChief Operations Officer Jun 1, 2019
W-2 Managing EmployeeChief Operations Officer Jun 1, 2019
Peggy Sanchez Individual Corporate DirectorBoard Treasurer May 21, 2012
James Alig Individual Corporate DirectorBoard Member Jan 1, 2014
Abigail Pascua Individual Corporate DirectorBoard Member Apr 1, 2022
Ava Phillips Individual Corporate DirectorBoard Member Jan 1, 2022
Elvia Rivas Individual Corporate DirectorBoard Member Feb 1, 2016
Michael Nelson Individual Corporate DirectorBoard Member Feb 1, 2016
Jonathan Berends Individual Corporate DirectorBoard Member Apr 1, 2022
Gwendolyn Keys Individual Corporate OfficerBoard Member Feb 1, 2016

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1487030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1154860963",
    "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": "2680 E RIVERSIDE DR",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917617307",
            "telephone_number": "909-630-7927",
            "fax_number": "909-620-6719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POMONA COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-14",
        "last_updated": "2017-02-14",
        "status": "A",
        "authorized_official_last_name": "SILVER",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "909-630-7939",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parktree Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ontario, CA

Sources for this page

Verify at the official NPI Registry.