NPIMap

Organization Active NPI

Asian and Pacific Islander Wellness Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Francisco, CA
National Provider Identifier
1376798413
Registry record updated Oct 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001294 Issued in CA
Legal business name
ASIAN AND PACIFIC ISLANDER WELLNESS CENTER, INC.
Practice address
726 Polk St
4TH Floor
San Francisco, CA 94109
Phone
(415) 292-3400
Fax
(415) 292-3404
NPI assigned
Nov 17, 2008
Last updated
Oct 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2016

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

Authorized official

Name
Mr. Lance Toma, LCSW
Title
Chief Executive Officer
Phone
(415) 292-3420

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Federally Qualified Health Center (FQHC) 261QF0400X 550001294 CA Primary

Addresses

Primary practice location

726 Polk St
4TH Floor
San Francisco, CA 94109

Mailing address

726 Polk St
4TH Floor
San Francisco, CA 94109
Phone (415) 292-3400

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160112003284 CA Part A Provider - Federally Qualified Health Center (FQHC) 0143522839 Practice locations: San Francisco, CA
O20160427002274 CA Part B Supplier - Clinic/Group Practice 0143522839 Receives reassigned benefits from 21 practitioners
1 other NPI on this enrollment
Practice locations: San Francisco, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376798413. Details of each certification follow.

Federally qualified health center certification: CCN 751850

Legal name
ASIAN AND PACIFIC ISLANDER WELLNESS CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 2016
Last certification
Jan 6, 2016
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Mar 27, 1988 in CA
Enrollment address
726 Polk St
# 4TH
San Francisco, CA 94109-7812

Other NPIs with the same Medicare PAC ID 1

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.

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
05D1020325Asian and Pacific Islander Wellness Center726 Polk St, 4TH FL, San Francisco, CA 94109Certificate of waiverDec 16, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Lance Toma Individual Corporate Director Aug 1, 2015
W-2 Managing Employee Aug 1, 2015 100%
Asian and Pacific Islander Wellness Center, Inc. Organization, San Francisco, CA Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2015 100%
5% Or Greater Indirect Ownership Interest Aug 1, 2015 100%
Operational/Managerial Control Aug 1, 2015 100%
Travis Austin Individual Corporate Director Aug 1, 2015 9.09%
Bart Aoki Individual Corporate Director Aug 1, 2015 9.09%
Royce C Lin Individual Corporate Director Aug 1, 2015 9.09%
Mario Choi Individual Corporate Director Aug 1, 2015 9.09%
Devesh Khatu Individual Corporate Director Aug 1, 2015 9.09%
Benjamin Leong Individual Corporate Director Aug 1, 2015 9.09%
Melinda Martin Individual Corporate Director Aug 1, 2015 9.09%
Gary Murakami Individual Corporate Director Aug 1, 2015 9.09%
Susan Philip Individual Corporate Director Aug 1, 2015 9.09%
Jack Song Individual Corporate Director Aug 1, 2015 9.09%
Erin Meek Individual Corporate Director Aug 1, 2015 9.09%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1226880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476316800000",
    "number": "1376798413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "726 POLK ST",
            "address_2": "4TH FLOOR",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94109",
            "telephone_number": "415-292-3400",
            "fax_number": "415-292-3404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "726 POLK ST",
            "address_2": "4TH FLOOR",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94109",
            "telephone_number": "415-292-3400",
            "fax_number": "415-292-3404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASIAN AND PACIFIC ISLANDER WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-17",
        "last_updated": "2016-10-13",
        "status": "A",
        "authorized_official_last_name": "TOMA",
        "authorized_official_first_name": "LANCE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "415-292-3420",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.