NPIMap

Organization Active NPI

Mission City Community Network, Inc

  • Primary Care Clinic/Center
  • Inglewood, CA
National Provider Identifier
1346525912
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
960000465 Issued in CA
Legal business name
MISSION CITY COMMUNITY NETWORK, INC
Practice address
301 N Prairie Ave
311
Inglewood, CA 90301-4507
Phone
(818) 895-3100
Fax
(818) 892-4651
NPI assigned
Oct 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Authorized official

Name
Nik Gupta
Title
Chief Executive Officer
Phone
(818) 895-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 960000465 CA Primary

Addresses

Primary practice location

301 N Prairie Ave
311
Inglewood, CA 90301-4507

Mailing address

15206 Parthenia St
North Hills, CA 91343-5305
Phone (818) 895-3100

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040204000544 CA Part B Supplier - Clinic/Group Practice 1658264684 Receives reassigned benefits from 152 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Hills, CA; Northridge, CA; Victorville, CA
O20120810000215 CA Part A Provider - Federally Qualified Health Center (FQHC) 1658264684 Practice locations: Inglewood, CA

Federally qualified health center certification: CCN 551183

Legal name
MISSION CITY COMMUNITY NETWORK, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 10, 2012
Last certification
Aug 10, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 6, 1989 in CA
Enrollment address
301 N Prairie Ave
Ste 311
Inglewood, CA 90301-4510

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Other NPIs on the same Medicare enrollment 8

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2037271Mission City Community Network, Inc301 N Prairie Ave Ste 311, Inglewood, CA 90301Certificate of waiverFeb 22, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Nik Gupta Individual Corporate OfficerBoard Member Mar 16, 2001
Corporate DirectorCeo Jul 1, 2009
W-2 Managing EmployeeCeo Jul 1, 2009
Frank Gonzales Individual Corporate OfficerBoard Member Jun 13, 2017
Aida Vlught Individual Corporate OfficerBoard Member Jul 1, 2000
Norma J Solis Individual Corporate DirectorBoard Member Jun 30, 2021
Maria Chaudhry Individual Corporate OfficerBoard Member Dec 1, 2012
Sammy Riley Individual Corporate OfficerBoard Member Feb 23, 2021
Mark Berry Individual Corporate OfficerBoard Member Aug 19, 2017
Adriana Guzman Individual Corporate OfficerBoard Member Mar 17, 2014
Magdalena Almira Individual Corporate OfficerBoard Member Feb 20, 2007
Rosalind Scarbrough Individual Corporate OfficerBoard Member Feb 23, 2021
Derek Biesheuvel Individual Corporate OfficerBoard Member Mar 17, 2014

NPI Registry JSON

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318550400000",
    "number": "1346525912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15206 PARTHENIA ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435305",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N PRAIRIE AVE",
            "address_2": "311",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903014507",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2011-10-14",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "NIK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "818-895-3100"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "960000465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

Verify at the official NPI Registry.