NPIMap

Organization Active NPI

Emanate Health Medical Center

Doing business as Emanate Health Inter-Community Hospital

  • Psychiatric Hospital Unit
  • Covina, CA
National Provider Identifier
1215063151
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
EMANATE HEALTH MEDICAL CENTER
Doing business as
Emanate Health Inter-Community Hospital
Intercommunity Medical Center Mental Health
Practice address
210 W San Bernardino Rd
Covina, CA 91723-1515
Phone
(626) 331-7331
NPI assigned
Feb 26, 2007
Last updated
Oct 27, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
EMANATE HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Authorized official

Name
Roger Sharma
Title
Executive VP/Cfo
Phone
(626) 938-7595

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X Primary

Addresses

Primary practice location

210 W San Bernardino Rd
Covina, CA 91723-1515

Mailing address

PO Box 840145
Los Angeles, CA 90084-0145
Phone (626) 331-7331

Other names 3

  • Emanate Health Inter-Community Hospital Doing business as
  • Intercommunity Medical Center Mental Health Doing business as
  • Citrus Valley Medical Center,Inc Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071102000637 CA Part A Provider - Hospital 0143317453 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Covina, CA; West Covina, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215063151. Details of each certification follow.

Hospital certification: CCN 050382

Legal name
EMANATE HEALTH MEDICAL CENTER
Doing business as
EMANATE HEALTH INTER-COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 14, 2023
Beds
193
Ownership / control type
Private (for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 4, 1959 in CA
Enrollment address
210 W San Bernardino Rd
Covina, CA 91723-1515
Hospital subgroups
General, Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Emanate Health Inter-Community HospitalCCN 050382 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Queen of the Valley4 organizations share this tax ID, including this one
Part of
Citrus Valley Health Partners

Other organizations with this tax ID 3

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

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
Walter Allen Individual Corporate DirectorBoard Member Jun 1, 2024
Gary Mathewson Individual Corporate Director Oct 30, 2007
Sanjay Natverlal Khedia Individual Corporate Director Sep 1, 2023
Raffaele M Corbisiero Individual Corporate DirectorBoard Member Jan 1, 2024
Thomas O. Bryan Individual Corporate Director Jun 1, 2024
Clifford Charles Christ Individual Corporate Director Oct 30, 2007
Rajesh K Sharma Individual Corporate OfficerPresident/Ceo Jul 31, 2013
Philip B Maldonado Individual Corporate Officer Jun 1, 2023
Patsy Gorrell Individual Corporate Director Oct 30, 2007
Mary Kirchen Individual Corporate Director Oct 30, 2007
Emanate Health Organization, Covina, CA Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 15, 2018 100%
Operational/Managerial Control Oct 15, 2018 100%
Sharon Juliana Yee Individual Corporate DirectorBoard Member Jun 1, 2016
Lucrecia Montes Individual Corporate Director Jun 1, 2016
Brenda N Hayakawa Individual Corporate DirectorBoard Member Jan 1, 2024
Robert Gonzales Individual Corporate Officer Jan 1, 2023
Eddie Arvayo Individual Operational/Managerial ControlFinance Director Feb 1, 2023

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Affiliated clinicians 469

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 469

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1215063151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840145",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900840145",
            "telephone_number": "626-331-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W SAN BERNARDINO RD",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917231515",
            "telephone_number": "626-331-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMANATE HEALTH MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMANATE HEALTH",
        "enumeration_date": "2007-02-26",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "SHARMA",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "EXECUTIVE VP/CFO",
        "authorized_official_telephone_number": "626-938-7595"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emanate Health Inter-Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Intercommunity Medical Center Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Citrus Valley Medical Center,Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Citrus Valley Medical Center,Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.