NPIMap

Organization Active NPI

The Los Angeles Free Clinic

Doing business as Saban Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1194893248
Registry record updated Aug 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THE LOS ANGELES FREE CLINIC
Doing business as
Saban Community Clinic
Practice address
8405 Beverly Blvd
Los Angeles, CA 90048-3401
Phone
(323) 653-8622
NPI assigned
Nov 30, 2006
Last updated
Aug 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2024

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

Authorized official

Name
Muriel Nouwezem
Title
Ceo
Phone
(323) 337-1707

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X CA
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

8405 Beverly Blvd
Los Angeles, CA 90048-3401

Mailing address

8405 Beverly Blvd
Los Angeles, CA 90048-3401

Other identifiers 8

IdentifierTypeStateIssuer
CMM70945FMedicaidCA
EAP00005FMedicaidCA
BCP70701FMedicaidCA
HAP70701FMedicaidCA
HAP70654FMedicaidCA
FHC70654FMedicaidCA
BCP70654FMedicaidCA
FHC70701FMedicaidCA

Other names 1

  • Saban Community Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100112000638 CA Part B Supplier - Clinic/Group Practice 5395886311 Receives reassigned benefits from 64 practitioners
2 other NPIs on this enrollment
Practice locations: Los Angeles, CA
O20120802000275 CA Part A Provider - Federally Qualified Health Center (FQHC) 5395886311 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194893248. Details of each certification follow.

Federally qualified health center certification: CCN 551181

Legal name
THE LOS ANGELES FREE CLINIC
Doing business as
SABAN COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 2, 2012
Last certification
Aug 2, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 11, 1967 in CA
Enrollment address
8405 Beverly Blvd
Los Angeles, CA 90048-3401

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Locations

8405 Beverly Blvd
West Hollywood, CA 90048
Phone (323) 653-1990

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
The Los Angeles Free Clinic Organization, Los Angeles, CA Non-profit Other Dec 14, 1967 100%
Muriel Nouwezem Individual Corporate OfficerInterim Ceo Jun 1, 2018 100%
W-2 Managing EmployeeCfo Sep 1, 2013

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Saban Community Clinic the Center at Blessed SacramentLos Angeles, CA, CCN 921931 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 28, 2020
Saban Community Clinic - the VirgilLos Angeles, CA, CCN 921932 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 13, 2020

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 69

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 69

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1194893248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8405 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900483401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8405 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900483401",
            "telephone_number": "323-653-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LOS ANGELES FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-30",
        "last_updated": "2024-08-30",
        "certification_date": "2024-08-30",
        "status": "A",
        "authorized_official_last_name": "NOUWEZEM",
        "authorized_official_first_name": "MURIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-337-1707"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70945F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EAP00005F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP70701F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP70701F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP70654F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70654F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP70654F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70701F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saban Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.