NPIMap

Organization Active NPI

Heritage Clinic and the Community Assistance Program for Seniors

Doing business as Heritage Clinic & Community Assistance Programs for Seniors

  • Clinical Psychologist
  • Long Beach, CA
National Provider Identifier
1376681163
Registry record updated Feb 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY17307 Issued in CA
Legal business name
HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS
Doing business as
Heritage Clinic & Community Assistance Programs for Seniors
Practice address
3939 Atlantic Ave
Suite 103
Long Beach, CA 90807-3536
Phone
(562) 264-6001
Fax
(562) 264-6006
NPI assigned
Feb 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2022

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

Authorized official

Name
Dr. Jamie Garis, PSY.D.
Title
Program Director
Phone
(626) 577-8480

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PSY17307 CA Primary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Supports Brokerage Agency 251X00000X

Addresses

Primary practice location

3939 Atlantic Ave
Suite 103
Long Beach, CA 90807-3536

Mailing address

447 N El Molino Ave
Pasadena, CA 91101-1403
Phone (626) 577-8480

Other names 1

  • Heritage Clinic & Community Assistance Programs for Seniors Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040412001075 CA Part B Supplier - Clinic/Group Practice 9032005798 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pasadena, CA; West Covina, CA; Los Angeles, CA; Long Beach, CA; Lancaster, CA

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Heritage Clinic and the Community Assistance Program for Seniors4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1376681163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 N EL MOLINO AVE",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911011403",
            "telephone_number": "626-577-8480",
            "fax_number": "626-577-8978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 ATLANTIC AVE",
            "address_2": "SUITE 103",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908073536",
            "telephone_number": "562-264-6001",
            "fax_number": "562-264-6006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE CLINIC AND THE COMMUNITY ASSISTANCE PROGRAM FOR SENIORS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "GARIS",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "626-577-8480",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY17307",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Heritage Clinic & Community Assistance Programs for Seniors",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Heritage Clinic & Community Assistance Programs for Seniors",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.