NPIMap

Organization Active NPI

San Fernando Community Hospital

Doing business as San Fernando Community Health Center

  • Primary Care Clinic/Center
  • San Fernando, CA
National Provider Identifier
1245669555
Registry record updated Apr 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SAN FERNANDO COMMUNITY HOSPITAL
Doing business as
San Fernando Community Health Center
Practice address
732 Mott St
Suite 100
San Fernando, CA 91340-4237
Phone
(818) 963-5690
Fax
(818) 365-0726
NPI assigned
Nov 6, 2013
Last updated
Apr 21, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2020

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

Authorized official

Name
Ms. Audrey L. Simons, MSHA
Title
Chief Executive Officer
Phone
(818) 365-5059

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 20A14847 CA
Dental Clinic/Center 261QD0000X
Primary Care Clinic/Center 261QP2300X Primary
Pediatric Skilled Nursing Facility 3140N1450X A48255 CA

Addresses

Primary practice location

732 Mott St
Suite 100
San Fernando, CA 91340-4237

Mailing address

732 Mott St
Suite 100
San Fernando, CA 91340-4237
Phone (818) 963-5690

Other identifiers 1

IdentifierTypeStateIssuer
4640840MedicaidCA

Other names 1

  • San Fernando Community Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address asimons@sfchealthcenter.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20150617002164 CA Part B Supplier - Clinic/Group Practice 7719298728 Receives reassigned benefits from 9 practitioners
Practice locations: San Fernando, CA
O20151112002518 CA Part A Provider - Federally Qualified Health Center (FQHC) 7719298728 Practice locations: San Fernando, CA
O20201026002353 CA MDPP Supplier - in-Person MDPP Supplier 7719298728 Practice locations: San Fernando, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1245669555. Details of each certification follow.

Federally qualified health center certification: CCN 751803

Legal name
SAN FERNANDO COMMUNITY HOSPITAL
Doing business as
SAN FERNANDO COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 16, 2015
Last certification
Nov 16, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 2, 1974 in CA
Enrollment address
732 Mott Street
Ste 100
San Fernando, CA 91340-4240

Hospital certification: CCN 050199

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
SAN FERNANDO COMMUNITY HOSPITAL
Certification status
Terminated Voluntary: merger or closure, Apr 1, 1995
Provider type (POS)
Hospital – Short-term
Participating since
May 19, 1976
Last certification
Sep 13, 1990
Beds
69
Ownership / control type
Other
Facility address
732 Mott St
San Fernando, CA 91340

National Provider Directory

National Provider Directory

Locations

732 Mott St
Ste 100
San Fernando, CA 91340
Phone (818) 365-5059

732 Mott St
Ste 100110
San Fernando, CA 91340
Phone (818) 963-5690

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Maritza Artan Individual Corporate DirectorBoard Member Jul 12, 2013
Cesar a de la Cruz Individual Corporate DirectorBoard Treasurer Jul 12, 2013
Martin L Adams Individual Corporate DirectorBoard Chair Jul 12, 2013
Troy Halpern Individual Corporate DirectorBoard Member Jul 12, 2013
Joni L Novosel Individual Corporate DirectorBoard Member Jul 12, 2013
Anne Louise Oliver Individual Corporate DirectorBoard Secretary Jul 12, 2013
Audrey L Simons Individual 5% Or Greater Direct Ownership InterestChief Executive Officer Aug 1, 2015
Corporate OfficerChief Executive Officer Jul 12, 2013
W-2 Managing EmployeeChief Executive Officer Jul 12, 2013
Operational/Managerial ControlChief Executive Officer Jul 12, 2013
Aaron D Morris Individual Corporate DirectorBoard Vice Chair Jul 12, 2013

Practitioners & affiliated clinicians

Practitioners 38

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 38

NPI Registry JSON

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

{
    "created_epoch": "1383696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587427200000",
    "number": "1245669555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 MOTT ST",
            "address_2": "SUITE 100",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913404237",
            "telephone_number": "818-963-5690",
            "fax_number": "818-365-0726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 MOTT ST",
            "address_2": "SUITE 100",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913404237",
            "telephone_number": "818-963-5690",
            "fax_number": "818-365-0726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN FERNANDO COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-06",
        "last_updated": "2020-04-21",
        "certification_date": "2020-04-21",
        "status": "A",
        "authorized_official_last_name": "SIMONS",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "818-365-5059",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MSHA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A14847",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "CA",
            "license": "A48255",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4640840",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "asimons@sfchealthcenter.org",
            "affiliation": "N",
            "address_1": "732 Mott St",
            "address_2": "Suite 100",
            "city": "San Fernando",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913404237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "San Fernando Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "San Fernando Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Fernando, CA

Sources for this page

Verify at the official NPI Registry.