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
1235271065
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
6043 Hollywood Blvd
Los Angeles, CA 90028-5411
Phone
(323) 653-8622
NPI assigned
Feb 12, 2007
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 960000818 CA
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

6043 Hollywood Blvd
Los Angeles, CA 90028-5411

Mailing address

6043 Hollywood Blvd
Los Angeles, CA 90028-5411
Phone (323) 653-8622

Other identifiers 8

IdentifierTypeStateIssuer
BCP70654FMedicaidCA
BCP70701FMedicaidCA
HAP70701FMedicaidCA
FHC70654FMedicaidCA
EAP00005FMedicaidCA
HAP70654FMedicaidCA
CMM70945FMedicaidCA
FHC70701FMedicaidCA

Other names 1

  • Saban Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

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
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN 551191

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
THE SABAN COMMUNITY CLINIC-HOLLYWOOD HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 19, 2012
Last certification
Sep 19, 2012
Ownership / control type
For profit – corporation
Facility address
6043 Hollywood Blvd
Hollywood, CA 90028

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

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724976000000",
    "number": "1235271065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6043 HOLLYWOOD BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900285411",
            "telephone_number": "323-653-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6043 HOLLYWOOD BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900285411",
            "telephone_number": "323-653-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LOS ANGELES FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "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": "960000818",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP70654F",
            "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": "FHC70654F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EAP00005F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP70654F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70945F",
            "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.