Southland Integrated Services, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTHLAND INTEGRATED SERVICES, INC.

Practice address

9862 Chapman Ave
Garden Grove, CA 92841-2726

Phone

(714) 620-7001

Fax

(714) 620-7091

NPI assigned

Nov 17, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Tricia Thao Nguyen, MPH

Title

Ceo

Phone

(714) 620-7007

Specialties & licenses 1

Addresses

Other names 1

• Vietnamese Community of Orange County, Inc. Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285708818. Details of each certification follow.

• CCN 051152 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 051152

Legal name

SOUTHLAND INTEGRATED SERVICES, INC.

Doing business as

SOUTHLAND HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 7, 2007

Last certification

Dec 7, 2007

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

May 29, 1979 in CA

Enrollment address

9862 Chapman Ave
Garden Grove, CA 92841-2711

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

CLIA laboratory certificates

Tax ID family

Southland Integrated Services Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Vcoc - Asian Health Center

  • Case Management Agency
  • Garden Grove, CA
  • NPI 1285067512
  NPD tax ID
• Vietnamese Community of Oragne County, Inc.

  • Case Management Agency
  • Garden Grove, CA
  • NPI 1740683903
  NPD tax ID

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

All disclosed owners & managing parties 11

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

Owners & managing parties with NPI records 1

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

• Kevin Khai Tuan Tieu, MD

  • Obstetrics & Gynecology Physician
  • Fountain Valley, CA
  • NPI 1154397768

  Corporate Director

  CMS ownership

Practitioners 8

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.

• Phuong Hoang Nguyen, NP

  • Nurse Practitioner
  • Garden Grove, CA
  • NPI 1851811301
  Medicare reassignment NPD
• Thuy-Anh Nguyen, D.O.

  • Family Medicine Physician
  • Garden Grove, CA
  • NPI 1609927722
  Medicare reassignment NPD
• Donny Tran, MD

  • Family Medicine Physician
  • Tustin, CA
  • NPI 1649319666
  Medicare reassignment NPD
• Theresa Nguyen Tran, NP-C

  • Family Nurse Practitioner
  • Tustin, CA
  • NPI 1568939833
  Medicare reassignment NPD
• Ngoc Nga Trinh DO, FNP-C

  • Family Nurse Practitioner
  • Garden Grove, CA
  • NPI 1972186179
  Medicare reassignment
• Hung Dinh Doan, M.D.

  • Family Medicine Physician
  • Garden Grove, CA
  • NPI 1376699918
  NPD (past)
• Huong Thi Hoang, DDS

  • General Practice Dentistry
  • Garden Grove, CA
  • NPI 1295860013
  NPD (past)
• Frances Thuy Tran, MD

  • Family Medicine Physician
  • Fountain Valley, CA
  • NPI 1225166606
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1285708818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9862 CHAPMAN AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928412726",
            "telephone_number": "714-620-7001",
            "fax_number": "714-620-7091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9862 CHAPMAN AVE",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928412726",
            "telephone_number": "714-620-7001",
            "fax_number": "714-620-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND INTEGRATED SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_middle_name": "THAO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-620-7007",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vietnamese Community of Orange County, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Federally Qualified Health Center (FQHC) in Garden Grove, CA
• Providers in Garden Grove, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.