NPIMap

Organization Active NPI

Share Our Selves Corporation

  • Federally Qualified Health Center (FQHC)
  • Anaheim, CA
National Provider Identifier
1184279952
Registry record updated Jul 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHARE OUR SELVES CORPORATION
Practice address
1000 N Kraemer PL Ste 204
Anaheim, CA 92806-2610
Phone
(949) 270-2100
Fax
(949) 650-4458
NPI assigned
Aug 7, 2019
Last updated
Jul 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2020

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

Authorized official

Name
Christy Ward
Title
Ceo
Phone
(949) 536-3927

Specialties & licenses 1

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

Addresses

Primary practice location

1000 N Kraemer PL Ste 204
Anaheim, CA 92806-2610

Mailing address

PO Box 10159
Costa Mesa, CA 92627-0050
Phone (949) 270-2100

Other names 1

  • SOS-Bridges Health Center Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110825000722 CA Part B Supplier - Clinic/Group Practice 4789854993 Receives reassigned benefits from 42 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Costa Mesa, CA; Mission Viejo, CA; Newport Beach, CA; Santa Ana, CA; Anaheim, CA
O20200728001441 CA Part A Provider - Federally Qualified Health Center (FQHC) 4789854993 Practice locations: Anaheim, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184279952. Details of each certification follow.

Federally qualified health center certification: CCN 921939

Legal name
SHARE OUR SELVES CORPORATION
Doing business as
SOS BRIDGES HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 20, 2020
Last certification
Jul 20, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 16, 1978 in CA
Enrollment address
1000 N Kraemer PL
Anaheim, CA 92806-2610

Other NPIs with the same Medicare PAC ID 7

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
Tax ID family
Share Our Selves Corporation10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

1000 N Kraemer Pl
Ste 204
Anaheim, CA 92806

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
Michelle Casteneda Individual Corporate Director Dec 13, 2017
Jay W Lee Individual Corporate OfficerCmo Feb 18, 2020
Rosario Lizbeth Galeas Individual Corporate Director Dec 13, 2017
Marc Harper Individual Corporate Director Jun 13, 2016
Allyson M Brooks Individual Corporate Director Apr 19, 2019
Ernest W Klatte Individual Corporate Director Jun 6, 2013
Susan Epstein Individual Corporate Director Jul 8, 2013
Mario Flores Individual Corporate OfficerCfo Mar 2, 2020
David Snow Individual Corporate Director Nov 13, 2017
John Yoo Individual Corporate Director Nov 13, 2017
Mary Ann Huntsman Individual Corporate OfficerCqo Mar 24, 2003
Gwyn P Parry Individual Corporate Director Jun 6, 2013
Christy Ward Individual Corporate OfficerCeo Sep 3, 2019
W-2 Managing Employee Sep 3, 2019

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Share Our Selves Children and Family Health CenterNewport Beach, CA, CCN 751856 Federally qualified health center Other (100%) Feb 1, 2016
Sos-El Sol Wellness CenterSanta Ana, CA, CCN 751858 Federally qualified health center Other (100%) Feb 2, 2016
Share OurselvesCosta Mesa, CA, CCN A01907 Federally qualified health center Other (100%) Sep 6, 2023

Owned or controlled facilities with NPI records 3

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

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": "1565136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595980800000",
    "number": "1184279952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10159",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926270050",
            "telephone_number": "949-270-2100",
            "fax_number": "949-650-4458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N KRAEMER PL STE 204",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928062610",
            "telephone_number": "949-270-2100",
            "fax_number": "949-650-4458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHARE OUR SELVES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-07",
        "last_updated": "2020-07-29",
        "certification_date": "2020-07-29",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-536-3927"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOS-Bridges Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.