NPIMap

Organization Active NPI

Universal Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1295493310
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNIVERSAL COMMUNITY HEALTH CENTER
Practice address
1021 W Martin Luther King Jr Blvd
Los Angeles, CA 90037-1816
Phone
(323) 233-3100
Fax
(323) 233-4100
NPI assigned
Dec 6, 2021
Last updated
Jan 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

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

Authorized official

Name
Alfredo Reynoso
Title
Coo
Phone
(323) 233-3100

Specialties & licenses 1

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

Addresses

Primary practice location

1021 W Martin Luther King Jr Blvd
Los Angeles, CA 90037-1816

Mailing address

2801 S San Pedro St
Los Angeles, CA 90011-2023
Phone (323) 233-3100

Other identifiers 1

IdentifierTypeStateIssuer
550003832MedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110125000952 CA Part B Supplier - Clinic/Group Practice 0547449399 Receives reassigned benefits from 39 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA
O20220812000763 CA Part A Provider - Federally Qualified Health Center (FQHC) 0547449399 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295493310. Details of each certification follow.

Federally qualified health center certification: CCN A01094

Legal name
UNIVERSAL COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 10, 2022
Last certification
Aug 10, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 14, 2009 in CA
Enrollment address
1021 W Martin Luther King Jr Blvd
Los Angeles, CA 90037-1816

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Universal Community Health Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1005 E Washington Blvd
Los Angeles, CA 90021
Phone (213) 745-3636

1021 W Martin Luther King Jr Blvd
Los Angeles, CA 90037
Phone (213) 744-9494

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)…

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Karina Arias Individual Corporate DirectorBoard Member Mar 31, 2010
Kathleen Momii Individual Corporate OfficerBoard Chair/President Mar 31, 2010
Corporate Director Mar 31, 2010
Edgar a Chavez Individual Corporate OfficerCeo Mar 31, 2010
W-2 Managing EmployeeCeo Jul 1, 2009

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Universal Community Health CenterLos Angeles, CA, CCN 921014 Federally qualified health center Operational/Managerial Control Jul 16, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1638748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1295493310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900112023",
            "telephone_number": "323-233-3100",
            "fax_number": "323-233-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 W MARTIN LUTHER KING JR BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900371816",
            "telephone_number": "323-233-3100",
            "fax_number": "323-233-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-06",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "REYNOSO",
        "authorized_official_first_name": "ALFREDO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "323-233-3100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "550003832",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.