NPIMap

Organization Active NPI

Providence Facey Medical Foundation

Doing business as Facey Endoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Mission Hills, CA
National Provider Identifier
1194083824
Registry record updated Oct 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
PROVIDENCE FACEY MEDICAL FOUNDATION
Doing business as
Facey Endoscopy Center
Practice address
11333 Sepulveda Blvd
Suite 3200
Mission Hills, CA 91345-1116
Phone
(818) 837-5776
Fax
(818) 837-5810
NPI assigned
May 1, 2012
Last updated
Oct 22, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FACEY MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 22, 2026

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

Authorized official

Name
Donald Wayne Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

11333 Sepulveda Blvd
Suite 3200
Mission Hills, CA 91345-1116

Mailing address

PO Box 31001-4268
Pasadena, CA 91110-0001

Other names 1

  • FACEY ENDOSCOPY CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140225002162 CA Part B Supplier - Ambulatory Surgical Center 3173436276 Practice locations: Mission Hills, CA

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Facey Medical FoundationCCN 05C0002054
Medicare certification status
ActiveFrom the Provider of Services file

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
05D0558842Providence Facey Medical Foundation-11333 Sepulveda Blvd, Ste 100, Mission Hills, CA 91345ComplianceJul 31, 2026
05D2044481Providence Facey Medical Foundation11333 N. Sepulveda Blvd Ste. 3200, Mission Hills, CA 91345Certificate of waiverJul 24, 2026
05D2129761Providence Facey Medical Foundation-MH11333 Sepulveda Blvd Ste 1710, Mission Hills, CA 91345Certificate of waiverApr 24, 2027

National Provider Directory

National Provider Directory
Part of
Facey Medical Foundatio

Locations

1801 Lind Ave SW
Ste 9016
Renton, WA 98057

Practitioners & affiliated clinicians

Practitioners 226

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 226

NPI Registry JSON

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

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792627200000",
    "number": "1194083824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-4268",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911100001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11333 SEPULVEDA BLVD",
            "address_2": "SUITE 3200",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451116",
            "telephone_number": "818-837-5776",
            "fax_number": "818-837-5810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE FACEY MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FACEY MEDICAL FOUNDATION",
        "enumeration_date": "2012-05-01",
        "last_updated": "2026-10-22",
        "certification_date": "2026-10-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FACEY ENDOSCOPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FACEY ENDOSCOPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mission Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.