NPIMap

Organization Active NPI

Unicare Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fontana, CA
National Provider Identifier
1174984041
Registry record updated Mar 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNICARE COMMUNITY HEALTH CENTER, INC.
Practice address
16127 Foothill Blvd
Fontana, CA 92335-3374
Phone
(909) 347-0700
NPI assigned
Mar 18, 2016
Last updated
Mar 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2024

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

Authorized official

Name
Avetik Machkalyan
Title
Chief Executive Officer
Phone
(909) 988-2555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

16127 Foothill Blvd
Fontana, CA 92335-3374

Mailing address

437 N Euclid Ave
Ontario, CA 91762-3456
Phone (909) 988-2555

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150623001589 CA Part B Supplier - Clinic/Group Practice 8426369067 Receives reassigned benefits from 141 practitioners
20 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Colton, CA; Apple Valley, CA; San Bernardino, CA; Riverside, CA; Pomona, CA; Pacoima, CA; Ontario, CA; Los Angeles, CA…
O20170504000707 CA Part A Provider - Federally Qualified Health Center (FQHC) 8426369067 Practice locations: Fontana, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174984041. Details of each certification follow.

Federally qualified health center certification: CCN 751963

Legal name
UNICARE COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 19, 2017
Last certification
May 19, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 27, 1999 in CA
Enrollment address
16127 Foothill Blvd
Fontana, CA 92335-3374

Other NPIs with the same Medicare PAC ID 17

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

View all 17

Other NPIs on the same Medicare enrollment 20

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

View all 20

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
05D2113978Unicare Community Health Center Inc16127 Foothill Blvd, Fontana, CA 92335Certificate of waiverJun 2, 2028

National Provider Directory

National Provider Directory
Tax ID family
Unicare Community Health Center Inc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Lynda Leanne Reed Individual Corporate DirectorBoard Member Mar 14, 2017
Avetik Machkalyan Individual Corporate OfficerCeo Mar 14, 2017
W-2 Managing EmployeeCeo Mar 14, 2017
Garegin Pogosian Individual Corporate OfficerCfo Mar 14, 2017
W-2 Managing EmployeeCfo Mar 14, 2017
Vahan Grigoryan Individual Corporate DirectorBoard Member Mar 14, 2017
Alma R Enciso Individual Corporate DirectorTreasurer Mar 14, 2017
Kelly H Vo Individual Corporate OfficerExecutive Vice President Mar 14, 2017
W-2 Managing EmployeeExecutive Vice President Mar 14, 2017
Nazeli Nercessian Individual Corporate DirectorBoard Member Apr 11, 2017
Patricia Aguiar Individual Corporate DirectorBoard Secretary Mar 14, 2017
Amy R Mills Individual Corporate DirectorBoard Chair Mar 14, 2017
Ramona Gutierrez Individual Corporate DirectorBoard Member Mar 14, 2017
Heidy L Garcia Cardona Individual Corporate DirectorBoard Member Mar 14, 2017
Eduard Gyadukyan Individual Corporate OfficerCoo Mar 14, 2017
W-2 Managing EmployeeCoo Mar 14, 2017
Laura M Burger Individual Corporate DirectorBoard Member Mar 14, 2017
Alejandra Gutierrez Individual Corporate DirectorBoard Member Mar 14, 2017
William C Paley Individual Corporate DirectorChief Medical Officer Mar 14, 2017
Natalie Brewer Individual Corporate DirectorBoard Vice-Chair Mar 14, 2017

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 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710288000000",
    "number": "1174984041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 N EUCLID AVE",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917623456",
            "telephone_number": "909-988-2555",
            "fax_number": "909-391-3081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16127 FOOTHILL BLVD",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353374",
            "telephone_number": "909-347-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNICARE COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-18",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A",
        "authorized_official_last_name": "MACHKALYAN",
        "authorized_official_first_name": "AVETIK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "909-988-2555"
    },
    "taxonomies": [
        {
            "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 Fontana, CA

Sources for this page

Verify at the official NPI Registry.