NPIMap

Organization Active NPI

Hurtt Family Health Clinic Inc.

  • Federally Qualified Health Center (FQHC)
  • Tustin, CA
National Provider Identifier
1306965587
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
HURTT FAMILY HEALTH CLINIC INC.
Practice address
1 Hope Drive
Tustin, CA 92782-0221
Phone
(714) 247-0300
Fax
(714) 259-1598
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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

Authorized official

Name
Ms. Becky Carter
Title
Executive Director
Phone
(714) 247-8044

Specialties & licenses 1

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

Addresses

Primary practice location

1 Hope Drive
Tustin, CA 92782-0221

Mailing address

1 Hope Drive
Tustin, CA 92782-0221
Phone (714) 247-0300

Other identifiers 1

IdentifierTypeStateIssuer
CMM70904FMedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091210000500 CA Part A Provider - Federally Qualified Health Center (FQHC) 4183764814 Practice locations: Tustin, CA
O20110203000426 CA Part B Supplier - Clinic/Group Practice 4183764814 Receives reassigned benefits from 15 practitioners
6 other NPIs on this enrollment
Practice locations: Anaheim, CA; Tustin, CA

Federally qualified health center certification: CCN 551016

Legal name
HURTT FAMILY HEALTH CLINIC INC
Doing business as
HURTT FAMILY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 10, 2009
Last certification
Dec 10, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1 Hope Dr
Tustin, CA 92782-0221

Other NPIs with the same Medicare PAC ID 1

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

Locations

947 S Anaheim Blvd
Ste 260
Anaheim, CA 92805

1100 N Tustin Ave
Ste F
Santa Ana, CA 92705

1 Hope Dr
Ste M
Tustin, CA 92782

14642 Newport Ave
Ste 210400
Tustin, CA 92780

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
Derrick Keith Burton Individual Corporate DirectorSecretary Jun 16, 2023
Kevin I Metzger Individual Contracted Managing EmployeeCmo May 20, 2024
Corporate OfficerCmo May 20, 2024
Operational/Managerial ControlCmo May 20, 2024
Jorge Alberto Molina Individual Corporate DirectorTreasurer Jul 15, 2022
Christine Marie Hamilton Individual Corporate DirectorBoard Member Aug 16, 2024
Ali Hein Individual Corporate DirectorBoard Member Aug 8, 2023
Larry Gwilt Individual Contracted Managing EmployeeCfo May 16, 2019 50%
Corporate OfficerCfo May 16, 2019 50%
Operational/Managerial ControlCfo May 16, 2019 50%
Jina Lawler Individual Contracted Managing EmployeeCeo Nov 16, 2023 50%
Corporate OfficerCeo Nov 16, 2023 50%
Operational/Managerial ControlCeo Nov 16, 2023 50%
Darryl Brumfield Individual Corporate DirectorBoard Member May 17, 2024
Joe Gonzalez Individual Corporate DirectorPresident, Chairperson Feb 16, 2024

Owners & managing parties with NPI records 1

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

  • Kevin Metzger, DO
    • Family Medicine Physician
    • Rancho Cucamonga, CA
    • NPI 1689847725

    Contracted Managing Employee, Corporate Officer, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574726400000",
    "number": "1306965587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOPE DRIVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927820221",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOPE DRIVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927820221",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HURTT FAMILY HEALTH CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2019-11-26",
        "status": "A",
        "authorized_official_last_name": "CARTER",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "714-247-8044",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM70904F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.