NPIMap

Organization Active NPI

Greater Fresno Health Organization Inc.

Doing business as North Marks Medical Clinic

  • Clinic/Center
  • Fresno, CA
National Provider Identifier
1184049793
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GREATER FRESNO HEALTH ORGANIZATION INC.
Doing business as
North Marks Medical Clinic
Practice address
4011 N Marks Ave
Fresno, CA 93722-4555
Phone
(559) 860-4925
NPI assigned
Feb 19, 2014
Last updated
May 1, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Authorized official

Name
Ms. Bla Mouanoutoua
Title
Ceo
Phone
(559) 255-6476

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

4011 N Marks Ave
Fresno, CA 93722-4555

Mailing address

4011 N Marks Ave
Fresno, CA 93722-4555
Phone (559) 860-4925

Other names 1

  • North Marks Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140828001050 CA Part A Provider - Federally Qualified Health Center (FQHC) 2860523990 Practice locations: Fresno, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184049793. Details of each certification follow.

Federally qualified health center certification: CCN 751091

Legal name
GREATER FRESNO HEALTH ORGANIZATION INC
Doing business as
NORTH MARKS MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 2, 2014
Last certification
Sep 2, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 3, 1994 in CA
Enrollment address
4011 N Marks Ave
Fresno, CA 93722-4555

Other NPIs with the same Medicare PAC ID 2

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

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
05D2077804North Marks Medical Clinic4011 N Marks Ave, Fresno, CA 93722Provider-performed microscopyMay 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Kings Winery Medical3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Howard Thao Individual Corporate DirectorBoard Member Apr 1, 1996
Panou Xiong Thao Individual Corporate Director Nov 26, 2023
Lorenzo Thomas Individual Corporate DirectorBoard Member Dec 1, 2013
Greater Fresno Health Organization Inc Organization, Fresno, CA 5% Or Greater Direct Ownership Interest Jul 1, 2014 100%
Thomas Her Individual Corporate DirectorBoard Member Jul 1, 2014
Bla Mouanoutoua Individual Corporate OfficerCeo Jun 1, 2020
W-2 Managing EmployeeCeo Jun 1, 2020 100%
Alfonso Sanchez Individual Corporate DirectorBoard Member Dec 1, 2011
Schoua Her Individual Corporate Director Apr 15, 2020
Susie Prop Individual Corporate DirectorDirector Jul 15, 2014

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Cedar University ClinicFresno, CA, CCN 921142 Federally qualified health center Operational/Managerial Control (100%) Sep 4, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 6

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": "1392768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1184049793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4011 N MARKS AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937224555",
            "telephone_number": "559-860-4925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4011 N MARKS AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937224555",
            "telephone_number": "559-860-4925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER FRESNO HEALTH ORGANIZATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-19",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "MOUANOUTOUA",
        "authorized_official_first_name": "BLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "559-255-6476",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Marks Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.