NPIMap

Organization Active NPI

St. Johns Community Health

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1174225429
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ST. JOHNS COMMUNITY HEALTH
Practice address
1741 E 120TH St FL 2
Los Angeles, CA 90059-3051
Phone
(323) 541-1600
Fax
(323) 541-1683
NPI assigned
Mar 20, 2023
Last updated
Feb 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Authorized official

Name
Mrs. Maria Socorro Genie
Title
Executive Project Director
Phone
(323) 541-1600

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Contractor 171W00000X NU
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

1741 E 120TH St FL 2
Los Angeles, CA 90059-3051

Mailing address

808 W 58TH St
Los Angeles, CA 90037-3632
Phone (323) 541-1600

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL HIE Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040722001434 CA Part B Supplier - Clinic/Group Practice 2961482690 Receives reassigned benefits from 440 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Lynwood, CA; San Bernardino, CA; San Jacinto, CA; Compton, CA; Indio, CA
O20240213002204 CA Part A Provider - Federally Qualified Health Center (FQHC) 2961482690 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174225429. Details of each certification follow.

Federally qualified health center certification: CCN A01847

Legal name
ST. JOHN'S COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 29, 2024
Last certification
Feb 29, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1741 E 120TH St
Ste 200
Los Angeles, CA 90059-3051

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
St Johns Community Health35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
William E Dawe Individual Corporate DirectorBoard Treasurer Aug 10, 2002
Joanna Choi Individual Corporate DirectorBoard Member Jan 1, 2014
Elizabeth M Meisler Individual Corporate OfficerCfo Sep 14, 2009
Lilia Garcia Individual Corporate DirectorBoard Chair Jul 5, 2002
James J Mangia Individual Corporate OfficerCeo Jan 10, 1993
W-2 Managing EmployeeCeo Jan 10, 1993
Ernesto Barahona Individual Corporate OfficerCoo Aug 12, 2016
Sushant Bandarpalle Individual Corporate OfficerCmo Jun 27, 2023
Martha Ortiz Individual Corporate DirectorBoard Member Jun 6, 2002

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 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707782400000",
    "number": "1174225429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1600",
            "fax_number": "323-541-1683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1741 E 120TH ST FL 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593051",
            "telephone_number": "323-541-1600",
            "fax_number": "323-541-1683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNS COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-20",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "GENIE",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "SOCORRO",
        "authorized_official_title_or_position": "EXECUTIVE PROJECT DIRECTOR",
        "authorized_official_telephone_number": "323-541-1600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "171W00000X",
            "taxonomy_group": "",
            "desc": "Contractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "HIE",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "1741 E 120th St Fl 2",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900593051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.