NPIMap

Organization Active NPI

Community Care Medical Center Inc.

Doing business as CCMC/Community Care Medical Center

  • Clinic/Center
  • North Hollywood, CA
National Provider Identifier
1265093520
Registry record updated May 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
COMMUNITY CARE MEDICAL CENTER INC.
Doing business as
CCMC/Community Care Medical Center
Practice address
13118 Sherman Way
North Hollywood, CA 91605
Phone
(818) 308-6318
Fax
(818) 308-6373
NPI assigned
Jun 26, 2019
Last updated
May 6, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2021

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

Authorized official

Name
Mrs. Wendi M. Rodriguez, ADMINISTRATOR
Title
Ceo/Administrator
Phone
(818) 308-6318

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Community Health Clinic/Center 261QC1500X

Addresses

Primary practice location

13118 Sherman Way
North Hollywood, CA 91605

Mailing address

13118 Sherman Way
North Hollywood, CA 91605
Phone (818) 308-6318

Other names 1

  • CCMC/Community Care Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ccmcmanagement@hotmail.com Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200309001413 CA Part B Supplier - Clinic/Group Practice 9133557010 Receives reassigned benefits from 5 practitioners
Practice locations: North Hollywood, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2174999Community Care Medical Center Inc13118 Sherman Way, North Hollywood, CA 91605Certificate of waiverNov 12, 2027

National Provider Directory

National Provider Directory

Locations

13118 Sherman Way
North Hollywood, CA 91605
Phone (818) 255-5382

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620259200000",
    "number": "1265093520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13118 SHERMAN WAY",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "91605",
            "telephone_number": "818-308-6318",
            "fax_number": "818-308-6373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13118 SHERMAN WAY",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "91605",
            "telephone_number": "818-308-6318",
            "fax_number": "818-308-6373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY CARE MEDICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-26",
        "last_updated": "2021-05-06",
        "certification_date": "2021-05-06",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "WENDI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "818-308-6318",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ccmcmanagement@hotmail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Medical Records",
            "address_1": "13118 Sherman Way",
            "city": "North Hollywood",
            "state": "CA",
            "country_code": "US",
            "postal_code": "916054645",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "CCMC/Community Care Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Hollywood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.