Mission City Community Network, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MISSION CITY COMMUNITY NETWORK, INC.

Practice address

1661 W Broadway
Anaheim, CA 92802-1110

Phone

(818) 895-3100

NPI assigned

May 24, 2016

Last updated

Sep 25, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nik Gupta

Title

Ceo

Phone

(818) 895-3100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164870739. Details of each certification follow.

• CCN 921109 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921109

Legal name

MISSION CITY COMMUNITY NETWORK, INC - ANAHEIM

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Nov 13, 2018

Last certification

Nov 13, 2018

Ownership / control type

For profit – corporation

Facility address

1661 West Broadway, Unit 11
Anaheim, CA 92802

Practitioners 1

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.

• John Robert Fernandez, M.D.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1770518920
  NPD (past)

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

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537833600000",
    "number": "1164870739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15206 PARTHENIA ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1661 W BROADWAY",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928021110",
            "telephone_number": "818-895-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-24",
        "last_updated": "2018-09-25",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "NIK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-895-3100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley E. Mires, M.D.
• Heather Mironas
• Haseena B Mirza, PA
• Alireza Mirzabozorg, M.D.
• Prasanthi Koduru Mishra, M.D.
• Manharlal M Mistry, D.D.S.
• Alexis Mitchell
• Ashley Lauren Mitchell
• Martin Dale Mitchell Jr.
• Thomas S Mitchell, PTA

• Federally Qualified Health Center (FQHC) in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.