NPIMap

Organization Active NPI

Universal Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1174913776
Registry record updated Sep 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNIVERSAL COMMUNITY HEALTH CENTER
Practice address
2801 S San Pedro St
Los Angeles, CA 90011-2023
Phone
(323) 233-3100
Fax
(323) 233-3124
NPI assigned
Feb 3, 2015
Organization subpart
Yes
Parent organization
UNIVERSAL COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 3, 2019

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

Authorized official

Name
Edgar Alexander Chavez, MD
Title
Ceo
Phone
(323) 233-3100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X A92965 CA
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2801 S San Pedro St
Los Angeles, CA 90011-2023

Mailing address

2801 S San Pedro St
Los Angeles, CA 90011-2023
Phone (213) 745-3636

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110125000952 CA Part B Supplier - Clinic/Group Practice 0547449399 Receives reassigned benefits from 39 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA
O20171020000045 CA Part A Provider - Federally Qualified Health Center (FQHC) 0547449399 Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN 921014

Legal name
UNIVERSAL COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 19, 2017
Last certification
Oct 19, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 14, 2009 in CA
Enrollment address
2801 S San Pedro St
Los Angeles, CA 90011-2023

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Part of
Universal Community Health Center

Locations

900 E 33rd St
Los Angeles, CA 90011
Phone (232) 333-3100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Universal Community Health Center Organization, Los Angeles, CA Non-profit Operational/Managerial Control Jul 16, 2009
Daniel Molina Individual Corporate DirectorBoard Member Treasurer Jan 12, 2015
Angelica Ramirez Individual Corporate DirectorBoard Member Feb 3, 2015
Karina Arias Individual Corporate DirectorBoard Member Mar 8, 2017
Ruth Catalan Individual Corporate DirectorBoard Member Apr 26, 2017
Kathleen Momii Individual Corporate DirectorBoard Member President Mar 31, 2010
Peter Manternach Individual Corporate DirectorBoard Member Mar 8, 2017
Marisol Hernandez Individual Corporate DirectorBoard Member Jul 22, 2015
Lizette Martinez Individual Corporate DirectorBoard Member Nov 9, 2016
Edgar a Chavez Individual Corporate Director Jul 16, 2009
W-2 Managing Employee Jul 16, 2009
Operational/Managerial Control Jul 16, 2009
Robert Montes Individual Corporate DirectorBoard Member Nov 9, 2016
Michael Montoya Individual Corporate DirectorBoard Member VP Sep 14, 2011
Tiffanie Morgan Individual Corporate DirectorBoard Member Secretary Mar 11, 2015

Owners & managing parties with NPI records 7

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

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": "1422921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567468800000",
    "number": "1174913776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900112023",
            "telephone_number": "213-745-3636",
            "fax_number": "213-745-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900112023",
            "telephone_number": "323-233-3100",
            "fax_number": "323-233-3124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSAL COMMUNITY HEALTH CENTER",
        "enumeration_date": "2015-02-03",
        "last_updated": "2019-09-03",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-233-3100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A92965",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.