NPIMap

Organization Active NPI

Glendale Adventist Medical Center

Doing business as Adventist Health Glendale

  • Psychiatric Hospital Unit
  • Glendale, CA
National Provider Identifier
1336138403
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
930000059 Issued in CA
Legal business name
GLENDALE ADVENTIST MEDICAL CENTER
Doing business as
Adventist Health Glendale
Practice address
1509 Wilson Ter
Glendale, CA 91206-4007
Phone
(818) 409-8000
Fax
(818) 546-5600
NPI assigned
Oct 20, 2005
Last updated
Nov 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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

Authorized official

Name
Alice H Issai
Title
President
Phone
(818) 409-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 930000059 CA Primary

Addresses

Primary practice location

1509 Wilson Ter
Glendale, CA 91206-4007

Mailing address

1509 Wilson Ter
Glendale, CA 91206-4007
Phone (818) 409-8000

Other names 1

  • Adventist Health Glendale Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC / Office Ally

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110510000465 CA Part B Supplier - Clinic/Group Practice 4284692096 Receives reassigned benefits from 167 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Glendale, CA
O20130727000017 CA Part A Provider - Hospital 4284692096 Practice locations: Glendale, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336138403. Details of each certification follow.

Hospital certification: CCN 05S239

Legal name
GLENDALE ADVENTIST MEDICAL CENTER
Doing business as
ADVENTIST HEALTH GLENDALE
Organization structure
CorporationNon-profit
Incorporated
Aug 26, 1905 in CA
Enrollment address
1509 Wilson Ter
Glendale, CA 91206-4007
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Glendale Adventist Medical9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1509 Wilson Ter
Rm 4B13
Glendale, CA 91206
Phone (818) 409-8517

2560 Colorado Blvd
Los Angeles, CA 90041
Phone (323) 255-5409

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Robert M Bonner Individual Corporate OfficerTreasurer Oct 25, 2021
W-2 Managing Employee Oct 25, 2021
Kerry L Heinrich Individual Corporate Director Dec 16, 2014
Velino a Salazar Individual Corporate Director Sep 15, 2015
Meredith S Jobe Individual Corporate OfficerSecretary Mar 31, 2014
Alice H Issai Individual Corporate OfficerPresident Jul 2, 2018
Richard K Reiner Individual Corporate Director Jan 16, 2017
Joy a. Fehr Individual Corporate Director Oct 1, 2020
Jonathan J Daggett Individual Corporate DirectorBoard of Director Jan 1, 2024
Andrew R Davis Individual Corporate Director May 5, 2017
Todd N Hofheins Individual Corporate OfficerVice Chair Jan 24, 2022
Ann K Beckett Individual Corporate DirectorBoard of Director Jan 1, 2024
Marc K Woodson Individual Corporate DirectorBoard of Director Jan 1, 2019
John C Freedman Individual Corporate Director Sep 26, 2016
Jack W Wagner Individual Corporate DirectorBoard of Director Dec 1, 2022
Kenneth Jutzy Individual Corporate Director Jan 1, 2024
Bradford C Newton Individual Corporate Director Aug 16, 2021
Robert a Cherry Individual Corporate Director May 5, 2017
Larry L Innocent Individual Corporate DirectorBoard Member Sep 19, 2011
Adventist Health System/West Organization, Roseville, CA Non-profit Operational/Managerial Control Jun 16, 1980 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 105

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 105

Practitioners & affiliated clinicians

Practitioners 155

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 155

NPI Registry JSON

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1336138403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 WILSON TER",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064007",
            "telephone_number": "818-409-8000",
            "fax_number": "818-546-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 WILSON TER",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064007",
            "telephone_number": "818-409-8000",
            "fax_number": "818-546-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE ADVENTIST MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "ISSAI",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-409-8000"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "CA",
            "license": "930000059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC / Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1509 Wilson Ter",
            "city": "Glendale",
            "state": "CA",
            "country_code": "US",
            "postal_code": "912064007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Adventist Health Glendale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.