NPIMap

Organization Active NPI

Southern California Medical Center, Inc.

  • Community Health Clinic/Center
  • El Monte, CA
National Provider Identifier
1225357114
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Practice address
12100 Valley Blvd Ste 109a
El Monte, CA 91732-3161
Phone
(626) 575-7500
Fax
(626) 575-1956
NPI assigned
May 18, 2010
Last updated
Jun 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Authorized official

Name
Ellie Zare
Title
Sr. Program Manager
Phone
(818) 650-6700

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Community Health Clinic/Center 261QC1500X Primary
Dental Clinic/Center 261QD0000X
Non-Surgical Family Planning Clinic/Center 261QF0050X
Health Service Clinic/Center 261QH0100X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X
Medical Specialty Clinic/Center 261QM2500X
Physical Therapy Clinic/Center 261QP2000X
Primary Care Clinic/Center 261QP2300X
Radiology Clinic/Center 261QR0200X
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

12100 Valley Blvd Ste 109a
El Monte, CA 91732-3161

Mailing address

PO Box 436
Van Nuys, CA 91408-0436
Phone (818) 421-0809

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110607000460 CA Part B Supplier - Clinic/Group Practice 2769666817 Receives reassigned benefits from 48 practitioners
3 other NPIs on this enrollment
Practice locations: Long Beach, CA; Pico Rivera, CA; Van Nuys, CA; El Monte, CA
O20151118001622 CA Part A Provider - Federally Qualified Health Center (FQHC) 2769666817 Practice locations: El Monte, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225357114. Details of each certification follow.

Federally qualified health center certification: CCN 751966

Legal name
SOUTHERN CALIFORNIA MEDICAL CENTER INC
Doing business as
SOUTHERN CALIFORNIA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 22, 2015
Last certification
Oct 22, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 14, 2008 in CA
Enrollment address
12100 Valley Blvd
Ste 109a
El Monte, CA 91732-3161

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

12100 Valley Blvd
Ste 109A
El Monte, CA 91732
Phone (626) 575-7500

1627 E Anaheim St
Long Beach, CA 90813
Phone (562) 437-0373

1631 E Anaheim St
Long Beach, CA 90813

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Southern California Medical Center Inc Organization, Van Nuys, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 5, 2008 100%
John Pazirandeh Individual Corporate OfficerChief Financial Officer May 15, 2022
Nancy Mejia Individual W-2 Managing EmployeeSr. Operation Manager Jan 1, 2022
Steven Sanzo Individual Corporate OfficerChief Development Officer Jan 4, 2021
Ara Baghdasarian Individual Corporate OfficerChief Operation Officer May 1, 2022
Allen Hassen Individual Corporate OfficerChief Medical Officer Nov 1, 2024
Ellie Zare Individual Operational/Managerial ControlSr. Program Manager Jan 1, 2022

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 5

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

FacilityTypeRoleSince
Southern California Medical Center-Pico RiveraPico Rivera, CA, CCN 751049 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 5, 2008
Southern California Medical Center IncVan Nuys, CA, CCN 751943 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2011
Southern California Medical Center IncPomona, CA, CCN 921873 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 22, 2020
Southern California Medical CenterLong Beach, CA, CCN 921960 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 5, 2008
Southern California Medical Center IncWoodland Hills, CA, CCN A01885 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 5, 2008

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1225357114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 436",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914080436",
            "telephone_number": "818-421-0809",
            "fax_number": "562-699-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12100 VALLEY BLVD STE 109A",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917323161",
            "telephone_number": "626-575-7500",
            "fax_number": "626-575-1956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-18",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "ZARE",
        "authorized_official_first_name": "ELLIE",
        "authorized_official_title_or_position": "SR. PROGRAM MANAGER",
        "authorized_official_telephone_number": "818-650-6700"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Monte, CA

Sources for this page

Verify at the official NPI Registry.