NPIMap

Organization Active NPI

Providence Health System - Southern California

Doing business as Providence Saint Joseph Medical Center

  • General Acute Care Hospital
  • Burbank, CA
National Provider Identifier
1336173269
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Doing business as
Providence Saint Joseph Medical Center
Practice address
501 S Buena Vista St
Burbank, CA 91505-4809
Phone
(818) 847-3022
Fax
(310) 303-7575
NPI assigned
Jul 10, 2006
Last updated
May 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

501 S Buena Vista St
Burbank, CA 91505-4809

Mailing address

PO Box 31001-3017
Pasadena, CA 91110-3017

Other identifiers 5

IdentifierTypeStateIssuer
HSC30235GMedicaidCA
ZZT40235GMedicaidCA
ZZT30235GMedicaidCA
ZZZA1901ZOtherCABLUE SHIELD PROV#
050235OtherCABLUE CROSS PROV#

Other names 1

  • Providence Saint Joseph Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070130000776 CA Part A Provider - Hospital 0749190759 Practice locations: Burbank, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336173269. Details of each certification follow.

Hospital certification: CCN 050235

Legal name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Doing business as
PROVIDENCE SAINT JOSEPH MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Feb 6, 1973
Last certification
Sep 26, 2022
Beds
360
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 1903 in CA
Enrollment address
501 S Buena Vista St
Burbank, CA 91505-4809
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Providence Saint Joseph Medical CtrCCN 050235 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Providence Health System - Southern California5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations (25 of 30)

8536 Wilshire Blvd
Ste 201
Beverly Hills, CA 90211
Phone (310) 248-8299

1218 W Olive Ave
Burbank, CA 91506
Phone (818) 842-6429

191 S Buena Vista St
Ste 375A
Burbank, CA 91505
Phone (818) 729-0014

2006 W Burbank Blvd
Burbank, CA 91506
Phone (818) 843-0390

2211 W Magnolia Blvd
#145
Burbank, CA 91506
Phone (310) 853-3638

2211 W Magnolia Blvd
Ste 230
Burbank, CA 91506
Phone (818) 391-1028

239 W Olive Ave
Burbank, CA 91502
Phone (818) 842-7999

2601 W Alameda Ave
Ste 204
Burbank, CA 91505
Phone (310) 266-9989

2701 W Alameda Ave
Ste 400
Burbank, CA 91505
Phone (818) 842-4821

2701 W Alameda Ave
Ste 407
Burbank, CA 91505
Phone (818) 842-8000

15503 Ventura Blvd
Ste 170
Encino, CA 91436
Phone (818) 377-3820

16030 Ventura Blvd
Ste 100
Encino, CA 91436
Phone (818) 981-3688

16661 Ventura Blvd
Encino, CA 91436
Phone (818) 808-2828

1505 Wilson Ter
Ste 310
Glendale, CA 91206
Phone (818) 419-2597

1808 Verdugo Blvd
Glendale, CA 91208
Phone (310) 344-5002

1911 W Glenoaks Blvd
Ste B
Glendale, CA 91201
Phone (818) 843-6640

1127 Wilshire Blvd
Ste 1620
Los Angeles, CA 90017
Phone (213) 423-7200

1245 Wilshire Blvd
Ste 430
Los Angeles, CA 90017
Phone (213) 977-4156

8635 W 3rd St
Ste 295W
Los Angeles, CA 90048
Phone (310) 385-3353

880 S Atlantic Blvd
Ste 101
Monterey Park, CA 91754
Phone (626) 281-6969

17075 Devonshire St
Ste 307
Northridge, CA 91325
Phone (818) 832-5551

65 N Madison Ave
Ste 512
Pasadena, CA 91101
Phone (626) 577-0700

2740 S Bristol St
Ste 222
Santa Ana, CA 92704
Phone (714) 556-9512

4835 Van Nuys Blvd
Ste 109
Sherman Oaks, CA 91403
Phone (818) 784-3615

4940 Van Nuys Blvd
Ste 302
Sherman Oaks, CA 91403
Phone (310) 507-7748

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorDirector Jul 1, 2016
Richard S Blair Individual Corporate DirectorDirector Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorBoard Member Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Jason Kell Individual W-2 Managing EmployeeFinancial Executive Jan 1, 2026
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jul 1, 2016
Providence Health System-Southern California Organization, Renton, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2007 100%
Mary E Lyons Individual Corporate DirectorDirector Jul 1, 2016
Phyllis M Hughes Individual Corporate DirectorDirector Jul 1, 2016
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAuthorized Official Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard of Directors Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Dec 20, 2016
Gregory David Hoffman Individual Corporate OfficerPresident/Ceo & Treasurer Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorDirector Jul 1, 2016
Donna Markham Individual Corporate DirectorBoard Member Jan 1, 2024
Michael W Murphy Individual Corporate DirectorDirector Jan 1, 2020
Providence Health & Services Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate DirectorBoard Member Sep 1, 2022
Karl Keeler Individual W-2 Managing EmployeeChief Executive Aug 15, 2022
Eric D Sprunk Individual Corporate DirectorBoard Member Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident/Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

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 140

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

View all 140

Practitioners & affiliated clinicians

Practitioners 418

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 418

Affiliated clinicians 499

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 499

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1336173269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001-3017",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911103017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S BUENA VISTA ST",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054809",
            "telephone_number": "818-847-3022",
            "fax_number": "310-303-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSC30235G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT40235G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT30235G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV#",
            "identifier": "ZZZA1901Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROV#",
            "identifier": "050235",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Saint Joseph Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Saint Joseph Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.