NPIMap

Organization Active NPI

St. Johns Community Health

  • Community Health Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1417469495
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
ST. JOHNS COMMUNITY HEALTH
Practice address
4251 Crenshaw Blvd
Los Angeles, CA 90008-2536
Phone
(323) 541-1600
Fax
(323) 541-1661
NPI assigned
Oct 30, 2017
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Authorized official

Name
James Mangia
Title
President & Ceo
Phone
(323) 541-1601

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
ContractorGroup: 193200000X MULTI-SPECIALTY GROUP 171W00000X
Case Management Agency 251B00000X
Supports Brokerage Agency 251X00000X
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

4251 Crenshaw Blvd
Los Angeles, CA 90008-2536

Mailing address

808 W 58TH St
Los Angeles, CA 90037-3632
Phone (323) 541-1600

Other names 1

  • St. John's Well Child and Family Center, Inc. Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040722001434 CA Part B Supplier - Clinic/Group Practice 2961482690 Receives reassigned benefits from 440 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Lynwood, CA; San Bernardino, CA; San Jacinto, CA; Compton, CA; Indio, CA
O20190926003231 CA Part A Provider - Federally Qualified Health Center (FQHC) 2961482690 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417469495. Details of each certification follow.

Federally qualified health center certification: CCN 921038

Legal name
ST. JOHN'S COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 2018
Last certification
Feb 6, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
4251 Crenshaw Blvd
Los Angeles, CA 90008-2536

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
St Johns Well Child and Fam36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
William E Dawe Individual Corporate DirectorBoard Treasurer Aug 10, 2005
Joanna Choi Individual Corporate DirectorBoard Member Jan 1, 2014
Elizabeth M Meisler Individual Corporate OfficerCfo Sep 14, 2009
Lilia Garcia Individual Corporate DirectorBoard Chair Jul 5, 2002
James J Mangia Individual Corporate OfficerCeo Jan 10, 1993
W-2 Managing Employee Jan 10, 1993
Ernesto Barahona Individual Corporate OfficerCoo Aug 12, 2016
Sushant Bandarpalle Individual Corporate OfficerCmo Jun 27, 2023
Martha Ortiz Individual Corporate DirectorBoard of Director Member Jun 6, 2002

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 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1417469495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1600",
            "fax_number": "323-541-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4251 CRENSHAW BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900082536",
            "telephone_number": "323-541-1600",
            "fax_number": "323-541-1661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHNS COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "MANGIA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "323-541-1601"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Contractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. John's Well Child and Family Center, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.