San Judas Community Health Center, Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

SAN JUDAS COMMUNITY HEALTH CENTER, INC

Practice address

2972 Wilshire Blvd
Los Angeles, CA 90010-1101

Phone

(213) 484-0000

Fax

(213) 387-0011

NPI assigned

May 10, 2018

Organization subpart

No

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

Authorized official

Name

Mr. Nejat Rostami, M.D.

Title

Ceo

Phone

(310) 780-4674

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396235883. Details of each certification follow.

• CCN A01068 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN A01068

Legal name

SAN JUDAS COMMUNITY HEALTH CENTER INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 24, 2022

Last certification

Feb 24, 2022

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

May 18, 2016 in CA

Enrollment address

2972 Wilshire Blvd
Los Angeles, CA 90010-1101

Other NPIs with the same Medicare PAC ID 1

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

• San Judas Community Health Center, Inc.

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1184134827

  2365788999

  Same PAC ID

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

CLIA laboratory certificates

Tax ID family

San Judas Community Health Center Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• San Judas Community Health Center, Inc.

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1184134827
  NPD tax ID

All disclosed owners & managing parties 12

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

Owners & managing parties with NPI records 4

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

• Minal Borsada, MD

  • Internal Medicine Physician
  • Anaheim, CA
  • NPI 1457485500

  Corporate Officer

  CMS ownership
• Benjamin Rostami, MD

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1659830545

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• Nejat Rostami, M.D.

  • Specialist
  • Los Angeles, CA
  • NPI 1114064987

  Corporate Officer, W-2 Managing Employee

  CMS ownership
• San Judas Community Health Center, Inc.

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1184134827

  5% Or Greater Direct Ownership Interest

  CMS ownership

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• San Judas Community Health Center, Inc.

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1184134827

  5% Or Greater Direct Ownership Interest

  CMS ownership

Facilities with the same owner 1

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

• San Judas Community Health Center, Inc.

  • Clinic/Center
  • Los Angeles, CA
  • NPI 1184134827

  San Judas Community Health Center Inc

  CMS ownership

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525910400000",
    "number": "1396235883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1080 N WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900292310",
            "telephone_number": "213-484-0000",
            "fax_number": "213-387-0011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2972 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101101",
            "telephone_number": "213-484-0000",
            "fax_number": "213-387-0011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JUDAS COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-10",
        "last_updated": "2018-05-10",
        "status": "A",
        "authorized_official_last_name": "ROSTAMI",
        "authorized_official_first_name": "NEJAT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-780-4674",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Gabriel Valley Consulting Pathologists Medical Group, Inc.
• San Jose Dental
• Deejay San Juan
• Gabriela San Juan
• Lorina Serame San Juan
• San Judas Community Health Center, Inc.
• San Judas Medical Group Ipa
• San Judas Medical Group West (N. Rostami Medical Group, Inc.)
• Victor M San Lucas III III, CRNA
• San Lucas Medical Clinic, Inc.

• Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.