NPIMap

Organization Active NPI

Southern California Medical Center, Inc.

  • Community Health Clinic/Center
  • Van Nuys, CA
National Provider Identifier
1255729661
Registry record updated Nov 2, 2022
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
14550 Haynes St
Van Nuys, CA 91411-1613
Phone
(818) 650-6700
Fax
(818) 933-5038
NPI assigned
Jan 7, 2015
Last updated
Nov 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Authorized official

Name
Sheila Busheri
Title
Ceo
Phone
(818) 650-6700

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Clinic/Center 261Q00000X
Community Health Clinic/Center 261QC1500X Primary
Dental Clinic/Center 261QD0000X
Non-Surgical Family Planning Clinic/Center 261QF0050X
Federally Qualified Health Center (FQHC) 261QF0400X
Health Service Clinic/Center 261QH0100X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Primary Care Clinic/Center 261QP2300X
Radiology Clinic/Center 261QR0200X
Mammography Clinic/Center 261QR0206X

Addresses

Primary practice location

14550 Haynes St
Van Nuys, CA 91411-1613

Mailing address

14550 Haynes St FL 3
Van Nuys, CA 91411-4116
Phone (818) 650-6700

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
This NPI is an additional NPI on the enrollment
Practice locations: Long Beach, CA; Pico Rivera, CA; Van Nuys, CA; El Monte, CA
O20161117002521 CA Part A Provider - Federally Qualified Health Center (FQHC) 2769666817 Practice locations: Van Nuys, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255729661. Details of each certification follow.

Federally qualified health center certification: CCN 751943

Legal name
SOUTHERN CALIFORNIA MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 21, 2016
Last certification
Dec 21, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 14, 2008 in CA
Enrollment address
14550 Haynes St
Van Nuys, CA 91411-1613

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

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

14550 Haynes St
Fl 3
Van Nuys, CA 91411

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
Armando Raygoza Individual Corporate OfficerBoard Member Sep 1, 2011
Jose Barraza Individual Corporate OfficerBoard Member Sep 1, 2011
Southern California Medical Center Inc Organization, Van Nuys, CA Created for acquisition, Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 1, 2011 100%
Sheila Busheri Individual Corporate OfficerCeo Sep 1, 2011
Fred Tahmsbi Individual Corporate OfficerBoard Member Sep 1, 2011
Maria Ahumada Individual Corporate OfficerBoard Member Sep 1, 2011
Rosa Estorga Individual Corporate OfficerBoard Member Sep 1, 2011
Karla Solis Individual Corporate DirectorDirector of Quality Improvement Sep 19, 2016
Veronica Padilla Individual W-2 Managing EmployeeBilling Manager Dec 22, 2016
Naveed Torian Individual Corporate OfficerBoard Member Sep 1, 2011

Owners & managing parties with NPI records 4

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 CenterEl Monte, CA, CCN 751966 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 5, 2008
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 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1420588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1255729661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14550 HAYNES ST FL 3",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914114116",
            "telephone_number": "818-650-6700",
            "fax_number": "818-933-5038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14550 HAYNES ST",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914111613",
            "telephone_number": "818-650-6700",
            "fax_number": "818-933-5038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-07",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "BUSHERI",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-650-6700"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "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": "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": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

Verify at the official NPI Registry.