NPIMap

Organization Active NPI

Comprehensive Community Health Centers Inc

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1245210749
Registry record updated Feb 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMPREHENSIVE COMMUNITY HEALTH CENTERS INC
Practice address
5059 York Blvd
Los Angeles, CA 90042-1713
Phone
(323) 344-4144
Fax
(323) 344-4146
NPI assigned
Jan 19, 2006
Last updated
Feb 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2022

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

Authorized official

Name
Flora Poladyan
Title
Coo
Phone
(323) 454-4481

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Obstetrics & Gynecology Physician 207V00000X
Pediatrics Physician 208000000X
Case Manager/Care Coordinator 171M00000X

Addresses

Primary practice location

5059 York Blvd
Los Angeles, CA 90042-1713

Mailing address

801 S Chevy Chase Dr
20
Glendale, CA 91205-4431
Phone (323) 344-4144

Other identifiers 1

IdentifierTypeStateIssuer
FHC71008FMedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000548 CA Part B Supplier - Clinic/Group Practice 9638082456 Receives reassigned benefits from 66 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arleta, CA; Glendale, CA; Los Angeles, CA; N Hollywood, CA; Sunland, CA
O20100817000736 CA Part A Provider - Federally Qualified Health Center (FQHC) 9638082456 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245210749. Details of each certification follow.

Federally qualified health center certification: CCN 551967

Legal name
COMPREHENSIVE COMMUNITY HEALTH CENTERS INC
Doing business as
COMPREHENSIVE COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 2004
Last certification
Jun 7, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 13, 2002 in CA
Enrollment address
5059 York Blvd
Los Angeles, CA 90042-1713

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 5

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

National Provider Directory

National Provider Directory

Locations

15715 S Atlantic Ave
Compton, CA 90221

801 S Chevy Chase Dr
Ste 200
Glendale, CA 91205
Phone (818) 637-7980

801 S Chevy Chase Dr
Ste 250
Glendale, CA 91205
Phone (818) 265-2259

3191 Casitas Ave
Ste 216
Los Angeles, CA 90039

5059 York Blvd
Los Angeles, CA 90042
Phone (323) 344-4144

8527 Sepulveda Blvd
North Hills, CA 91343
Phone (310) 926-4865

12157 Victory Blvd
North Hollywood, CA 91606
Phone (818) 755-8000

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
David E Kenney Individual Corporate DirectorBoard of Directors Sep 14, 2009
Jean-Pierre E Antaki Individual Corporate DirectorBoard of Directors Sep 14, 2009
David G Lontok Individual Corporate OfficerCeo Mar 1, 2018
W-2 Managing EmployeeCeo May 4, 2020
Odet Mkrtchian Individual Corporate DirectorMember of Board of Directors Jan 15, 2018
Armen Der Abrahamian Individual Corporate DirectorBoard of Directors Mar 13, 2017
Nancy Guillen Individual Corporate DirectorBoard of Directors Nov 11, 2013
Maria E Amaya Individual Corporate DirectorBoard of Directors Nov 19, 2007
Ara Tavitian Individual Corporate DirectorMember of Board of Directors Mar 12, 2018
Flora Poladyan Individual Corporate OfficerCoo Oct 24, 2002
Greg Krikorian Individual Corporate DirectorBoard of Directors Apr 22, 2013

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644192000000",
    "number": "1245210749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S CHEVY CHASE DR",
            "address_2": "20",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912054431",
            "telephone_number": "323-344-4144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5059 YORK BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900421713",
            "telephone_number": "323-344-4144",
            "fax_number": "323-344-4146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A",
        "authorized_official_last_name": "POLADYAN",
        "authorized_official_first_name": "FLORA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "323-454-4481"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71008F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.