NPIMap

Organization Active NPI

Mission City Community Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Victorville, CA
National Provider Identifier
1265708994
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MISSION CITY COMMUNITY NETWORK, INC.
Practice address
15201 11TH St
Suite 300
Victorville, CA 92395-3735
Phone
(818) 895-3100
Fax
(818) 892-4651
NPI assigned
Mar 27, 2012
Last updated
Mar 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2012

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

Authorized official

Name
Mr. Nik Gupta
Title
Ceo
Phone
(818) 895-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

15201 11TH St
Suite 300
Victorville, CA 92395-3735

Mailing address

15206 Parthenia St
North Hills, CA 91343-5305
Phone (818) 895-3100

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040204000544 CA Part B Supplier - Clinic/Group Practice 1658264684 Receives reassigned benefits from 152 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Hills, CA; Northridge, CA; Victorville, CA
O20131017001374 CA Part A Provider - Federally Qualified Health Center (FQHC) 1658264684 Practice locations: Victorville, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265708994. Details of each certification follow.

Federally qualified health center certification: CCN 751036

Legal name
MISSION CITY COMMUNITY NETWORK, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 8, 2013
Last certification
Nov 8, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 26, 1988 in CA
Enrollment address
15201 11TH Street
Suite 300
Victorville, CA 92395

Other NPIs with the same Medicare PAC ID 18

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 18

Other NPIs on the same Medicare enrollment 8

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

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
05D2052001Mission City Community Network Inc15201 11TH St Ste 300, Victorville, CA 92395Certificate of waiverJan 2, 2027

National Provider Directory

National Provider Directory

Locations

15201 Eleventh St
Ste 300
Victorville, CA 92395
Phone (760) 245-1640

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Maria Chaudhry Individual Corporate DirectorBoard Member Dec 1, 2012
Nik Gupta Individual Corporate OfficerC.E.O. Mar 16, 2001
Corporate DirectorBoard Member Mar 16, 2001
W-2 Managing EmployeeC.E.O. Jul 9, 2013
Frank Gonzales Individual Corporate DirectorBoard Member Jun 13, 2017
Aida Vlught Individual Corporate DirectorBoard Member Jul 1, 2000
Sammy Riley Individual Corporate DirectorBoard Member Feb 23, 2021
Mark Berry Individual Corporate DirectorBoard Member Aug 19, 2017
Adriana Guzman Individual Corporate DirectorBoard Member Mar 17, 2014
Magdalena Almira Individual W-2 Managing EmployeeDelegated Official Officer Sep 11, 2023
Rosalind Scarbrough Individual Corporate DirectorBoard Member Feb 23, 2021

Practitioners & affiliated clinicians

Practitioners 41

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 41

NPI Registry JSON

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

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1265708994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15206 PARTHENIA ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435305",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15201 11TH ST",
            "address_2": "SUITE 300",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953735",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-27",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "NIK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-895-3100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.