NPIMap

Organization Active NPI

Celebrating Life Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Mission Viejo, CA
National Provider Identifier
1386273100
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CELEBRATING LIFE COMMUNITY HEALTH CENTER
Practice address
27800 Medical Center Rd Ste 110
Mission Viejo, CA 92691-6407
Phone
(949) 866-3600
NPI assigned
Apr 3, 2020
Last updated
Sep 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

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

Authorized official

Name
Mr. Sergey Sergeyev, MPA
Title
Ceo
Phone
(949) 866-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

27800 Medical Center Rd Ste 110
Mission Viejo, CA 92691-6407

Mailing address

27800 Medical Center Rd Ste 110
Mission Viejo, CA 92691-6407
Phone (949) 866-3600

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200519001984 CA Part B Supplier - Clinic/Group Practice 4789015140 Receives reassigned benefits from 9 practitioners
Practice locations: Mission Viejo, CA
O20210427002501 CA Part A Provider - Federally Qualified Health Center (FQHC) 4789015140 Practice locations: Mission Viejo, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386273100. Details of each certification follow.

Federally qualified health center certification: CCN 921956

Legal name
CELEBRATING LIFE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 27, 2021
Last certification
Apr 27, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 25, 2019 in CA
Enrollment address
27800 Medical Center Rd
Ste 110
Mission Viejo, CA 92691-6407

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory

Locations

27800 Medical Center Rd
Ste 202204
Mission Viejo, CA 92691

Interoperability endpoints

  • Direct secure messaging: aidamedawar@clchc.allscriptsdirect.net
  • Direct secure messaging: alecbradbury@clchc.allscriptsdirect.net
  • Direct secure messaging: alheliramirez@clchc.allscriptsdirect.net
  • Direct secure messaging: amandamacallister@clchc.allscriptsdirect.net
  • Direct secure messaging: andrewdoumar@clchc.allscriptsdirect.net
  • Direct secure messaging: annettekroes@clchc.allscriptsdirect.net
  • Direct secure messaging: azadehgolshani@clchc.allscriptsdirect.net
  • Direct secure messaging: bassamaziz@clchc.allscriptsdirect.net
  • Direct secure messaging: cindyquant@clchc.allscriptsdirect.net
  • Direct secure messaging: cindytafoya@clchc.allscriptsdirect.net
  • Direct secure messaging: claudineyamaoka@clchc.allscriptsdirect.net
  • Direct secure messaging: davidmir@clchc.allscriptsdirect.net
  • Direct secure messaging: donnaball@clchc.allscriptsdirect.net
  • Direct secure messaging: dukekim@clchc.allscriptsdirect.net
  • Direct secure messaging: earltrinidad@clchc.allscriptsdirect.net
  • Direct secure messaging: elainetrinidad@clchc.allscriptsdirect.net
  • Direct secure messaging: emilyha@clchc.allscriptsdirect.net
  • Direct secure messaging: evelinejho@clchc.allscriptsdirect.net
  • Direct secure messaging: faribashokoohy@clchc.allscriptsdirect.net
  • Direct secure messaging: hannazameni@clchc.allscriptsdirect.net

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
John N Le Individual Corporate OfficerChief Medical Officer Jul 1, 2020
W-2 Managing EmployeeChief Medical Officer Jul 1, 2020
Randolph Phillip Velasco Individual Corporate OfficerBoard Treasurer Dec 26, 2018
Valentina Artemova Individual Corporate OfficerBoard Secretary Dec 26, 2018
Sergey Sergeyev Individual Corporate OfficerChief Executive Officer Dec 26, 2018
Sylvia Caliendo Individual Corporate OfficerBoard Chair Dec 26, 2018

Practitioners & affiliated clinicians

Practitioners 49

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 49

NPI Registry JSON

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663891200000",
    "number": "1386273100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27800 MEDICAL CENTER RD STE 110",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916407",
            "telephone_number": "949-866-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27800 MEDICAL CENTER RD STE 110",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916407",
            "telephone_number": "949-866-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CELEBRATING LIFE COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-03",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-23",
        "status": "A",
        "authorized_official_last_name": "SERGEYEV",
        "authorized_official_first_name": "SERGEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-866-3600",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.