NPIMap

Organization Active NPI

South Central Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1396891909
Registry record updated Mar 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960000260 Issued in CA
Legal business name
SOUTH CENTRAL FAMILY HEALTH CENTER
Practice address
4425 S Central Ave
Los Angeles, CA 90011-3629
Phone
(323) 908-4239
Fax
(323) 908-4256
NPI assigned
Jan 26, 2007
Last updated
Mar 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2016

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

Authorized official

Name
Paul Ramos
Title
C.F.O.
Phone
(323) 908-4239

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 960000260 CA Primary

Addresses

Primary practice location

4425 S Central Ave
Los Angeles, CA 90011-3629

Mailing address

4425 S Central Ave
Los Angeles, CA 90011-3629
Phone (323) 908-4239

Other identifiers 4

IdentifierTypeStateIssuer
BCP70315FOtherCACANCER DETECTION PROGRAM
HAP70315FOtherCAFAMILY PLANNING
EAP70315FOtherCAEAPC
FHC70315FMedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100826000757 WI Part A Provider - Federally Qualified Health Center (FQHC) 5597675041 Practice locations: Los Angeles, CA
O20240621003215 CA Part B Supplier - Clinic/Group Practice 5597675041 Receives reassigned benefits from 35 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Huntington Park, CA; Cudahy, CA; Montebello, CA; Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396891909. Details of each certification follow.

Federally qualified health center certification: CCN 551865

Legal name
SOUTH CENTRAL FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 29, 1999
Last certification
Dec 29, 1999
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Apr 15, 1983 in CA
Enrollment address
4425 S Central Ave
Los Angeles, CA 90011-3629

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Locations

7910 Atlantic Ave
Ste M
Cudahy, CA 90201
Phone (323) 908-4247

3410 Hooper Ave
Los Angeles, CA 90011

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Genevieve Filmardirossian Individual Corporate OfficerChief Executive Officer Oct 16, 2006
W-2 Managing EmployeeChief Executive Officer Oct 16, 2006
Paul Ramos Individual Corporate OfficerChief Financial Officer Aug 6, 2002
Janice R Brittain Individual Corporate DirectorBoard Member May 27, 2008
Fernando Almodovar Individual Corporate DirectorBoard Chair Apr 26, 2011
Tumani S Moore-Leatherwood Individual Corporate DirectorBoard Vice Chair Dec 16, 2008
Rosie Rios Individual Corporate DirectorBoard Member May 27, 2008
Karen Minikes Individual Corporate DirectorBoard Member Aug 30, 2013
Erica Y Hernandez Individual Corporate DirectorBoard Secretary Oct 1, 2014
Amir a Johnson Individual Corporate DirectorBoard Treasurer Nov 4, 2014
Ruby a Raya-Morones Individual Corporate OfficerChief Medical Officer Apr 17, 2013

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
South Central Family Health Center-VernonLos Angeles, CA, CCN 921013 Federally qualified health center Operational/Managerial Control Jul 31, 2012
Cudahy Family Health CenterCudahy, CA, CCN 921079 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2016

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459296000000",
    "number": "1396891909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 S CENTRAL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900113629",
            "telephone_number": "323-908-4239",
            "fax_number": "323-908-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 S CENTRAL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900113629",
            "telephone_number": "323-908-4239",
            "fax_number": "323-908-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2016-03-30",
        "status": "A",
        "authorized_official_last_name": "RAMOS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "C.F.O.",
        "authorized_official_telephone_number": "323-908-4239"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960000260",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CANCER DETECTION PROGRAM",
            "identifier": "BCP70315F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMILY PLANNING",
            "identifier": "HAP70315F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP70315F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70315F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.