NPIMap

Organization Active NPI

JWCH Institute Inc

Doing business as JWCH Institute Inc Medical Clinic Weingart Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1407808058
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
950001280 Issued in CA
Legal business name
JWCH INSTITUTE INC
Doing business as
JWCH Institute Inc Medical Clinic Weingart Center
Practice address
522 S San Pedro St
Los Angeles, CA 90013-2102
Phone
(213) 622-2639
Fax
(213) 624-8738
NPI assigned
May 16, 2006
Last updated
Jun 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Authorized official

Name
Mr. Alvaro P Ballesteros
Title
Chief Executive Officer
Phone
(323) 201-4516

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Dental Clinic/Center 261QD0000X 950001280 CA
Federally Qualified Health Center (FQHC) 261QF0400X 950001280 CA Primary
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

522 S San Pedro St
Los Angeles, CA 90013-2102

Mailing address

5650 Jillson St
Commerce, CA 90040-1482
Phone (323) 201-4516

Other identifiers 1

IdentifierTypeStateIssuer
FHC70900FMedicaidCA

Other names 1

  • JWCH Institute Inc Medical Clinic Weingart Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060807000476 CA Part B Supplier - Clinic/Group Practice 1850394123 Receives reassigned benefits from 160 practitioners
7 other NPIs on this enrollment
Practice locations: Bellflower, CA; Downey, CA; Los Angeles, CA; Lynwood, CA; Norwalk, CA
O20061025000809 CA Part A Provider - Federally Qualified Health Center (FQHC) 1850394123 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407808058. Details of each certification follow.

Federally qualified health center certification: CCN 051068

Legal name
JWCH INSTITUTE INC
Doing business as
JWCH INSTITUTE INC MEDICAL CLINIC WEINGART CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2006
Last certification
Dec 14, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 4, 1960 in CA
Enrollment address
522 S San Pedro St
Los Angeles, CA 90013-2102

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

8530 Firestone Blvd
Downey, CA 90241
Phone (562) 862-1000

3591 E Imperial Hwy
Lynwood, CA 90262
Phone (310) 223-1035

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Thomas Grode Individual Corporate DirectorBoard Member Jan 26, 2016
Joseph Castel Individual Corporate DirectorBoard Member - Secretary Jul 13, 2004
Andy Irie Individual Corporate OfficerChief Administrative Officer Jan 1, 2010
Paul Gerald Gregerson Individual Corporate OfficerChief Medical Officer Jan 1, 2001
Jeanne Lam Individual Corporate OfficerChief Financial Officer Jul 1, 2005
Eduardo Saucedo Individual Corporate DirectorBoard Member Jul 26, 2016
Alvaro P Ballesteros Individual Corporate OfficerChief Executive Officer Oct 1, 2003
Annette Sullivan Individual Corporate DirectorBoard Member Feb 23, 2021
Herbert Torrence Individual Corporate DirectorBoard Member Feb 28, 2017
Kathleen House Individual Corporate DirectorBoard Member - Vice Chair Nov 22, 2011
Silvia Hernandez Individual Corporate DirectorBoard Member Sep 23, 2014
Lawrence Fernandez Individual Corporate DirectorBoard Member Jun 25, 2002
Maria a Padron Individual Corporate DirectorBoard Member Feb 14, 2007
Sheila Eaton Individual Corporate DirectorBoard Member Sep 24, 2013
Paul K Chu Individual Operational/Managerial ControlClinic Administrator Aug 1, 2004

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
JWCH Medical Clinic @ Bell ShelterBell, CA, CCN 751883 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2015
Wesley Health Centers - Palmdale CentralPalmdale, CA, CCN 921169 Federally qualified health center Operational/Managerial Control (100%) Apr 15, 2019

Practitioners & affiliated clinicians

Practitioners 166

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 166

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655856000000",
    "number": "1407808058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5650 JILLSON ST",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900401482",
            "telephone_number": "323-201-4516",
            "fax_number": "323-215-0171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900132102",
            "telephone_number": "213-622-2639",
            "fax_number": "213-624-8738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JWCH INSTITUTE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A",
        "authorized_official_last_name": "BALLESTEROS",
        "authorized_official_first_name": "ALVARO",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "323-201-4516",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "950001280",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "950001280",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70900F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "JWCH Institute Inc Medical Clinic Weingart Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "JWCH Institute Inc Medical Clinic Weingart Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.