NPIMap

Organization Active NPI

Altamed Health Services Corp

Doing business as AltaMed Medical Group-Orange,Chapman

  • Community Health Clinic/Center
  • Orange, CA
National Provider Identifier
1316116221
Registry record updated Jan 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
ALTAMED HEALTH SERVICES CORP
Doing business as
AltaMed Medical Group-Orange,Chapman
Practice address
4010 E Chapman Ave
Orange, CA 92869-3990
Phone
(323) 762-2242
Fax
(323) 889-7843
NPI assigned
Feb 25, 2008
Last updated
Jan 4, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2019

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

Authorized official

Name
Robert U. Young, M.D.
Title
VP, Patient Financial Services
Phone
(323) 622-2429

Specialties & licenses 1

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

Addresses

Primary practice location

4010 E Chapman Ave
Orange, CA 92869-3990

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (323) 622-2429

Other names 1

  • AltaMed Medical Group-Orange,Chapman Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100421000621 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Orange, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316116221. Details of each certification follow.

Federally qualified health center certification: CCN 551027

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-ORANGE, CHAPMAN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 21, 2010
Last certification
Apr 21, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
4010 E Chapman Ave
Orange, CA 92869-3990

Other NPIs with the same Medicare PAC ID 22

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

View all 22

National Provider Directory

National Provider Directory

Locations

2040 Camfield Ave
Commerce, CA 90040
Phone (323) 558-7677

4010 E Chapman Ave
Orange, CA 92869
Phone (714) 500-0360

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Maria Grimaldo Individual Corporate DirectorBoard Member Oct 29, 2013
Jose Avalos Individual Corporate DirectorChair, Board Member Jul 1, 2018
Castulo de la Rocha Individual Corporate OfficerPresident and Ceo Mar 1, 1997
Marc Victor Individual Corporate DirectorBoard Member Oct 26, 2017
Ricardo Robles Individual Corporate DirectorSecretary, Consumer Board Member Jan 22, 2015
Victor Olmos Individual Corporate DirectorTreasurer, Board Member Jan 1, 2021
Maria Cervantes Individual Corporate DirectorBoard Member Apr 27, 2023
Joseph Gomez Individual Corporate DirectorBoard Member Aug 22, 2019
Jose Ubaldo Esparza Individual Corporate OfficerEvp, Finance & Cfo Jan 20, 1997
Robert Young Individual W-2 Managing EmployeeVice President, PFS Jan 6, 2012
Nadia Paola Alvarez Individual Corporate DirectorBoard Member Aug 22, 2019
Lucy Maria Herrera Individual Corporate DirectorVice Chair, Consumer Board Member Jan 1, 2020

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1203897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546560000000",
    "number": "1316116221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 CAMFIELD AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900401501",
            "telephone_number": "323-622-2429",
            "fax_number": "323-889-7843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 E CHAPMAN AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928693990",
            "telephone_number": "323-762-2242",
            "fax_number": "323-889-7843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-25",
        "last_updated": "2019-01-04",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "U.",
        "authorized_official_title_or_position": "VP, PATIENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "323-622-2429",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AltaMed Medical Group-Orange,Chapman",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AltaMed Medical Group-Orange,Chapman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.