NPIMap

Organization Active NPI

Southern California Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Long Beach, CA
National Provider Identifier
1447865415
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Practice address
1627 E Anaheim St
Long Beach, CA 90813-3809
Phone
(532) 218-8181
Fax
(532) 218-8182
NPI assigned
Sep 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Authorized official

Name
Ellie Zare
Title
Sr. Program Manger
Phone
(818) 650-6700

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X
Community/Behavioral Health Agency 251S00000X
Clinic/Center 261Q00000X
Community Health Clinic/Center 261QC1500X
Non-Surgical Family Planning Clinic/Center 261QF0050X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X
Physical Therapy Clinic/Center 261QP2000X
Mammography Clinic/Center 261QR0206X
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

1627 E Anaheim St
Long Beach, CA 90813-3809

Mailing address

PO Box 436
Van Nuys, CA 91408-0436
Phone (818) 421-0809

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110607000460 CA Part B Supplier - Clinic/Group Practice 2769666817 Receives reassigned benefits from 48 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Long Beach, CA; Pico Rivera, CA; Van Nuys, CA; El Monte, CA
O20210528000768 CA Part A Provider - Federally Qualified Health Center (FQHC) 2769666817 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Long Beach, CA

Federally qualified health center certification: CCN 921960

Legal name
SOUTHERN CALIFORNIA MEDICAL CENTER INC
Doing business as
SOUTHERN CALIFORNIA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 28, 2021
Last certification
May 28, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 5, 2008 in CA
Enrollment address
1627 E Anaheim St
Long Beach, CA 90813-3809

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Southern California Medical Center Inc Organization, Van Nuys, CA Non-profit 5% Or Greater Direct Ownership Interest May 5, 2008 100%
John Pazirandeh Individual Corporate OfficerChief Financial Officer May 15, 2022
Nancy Mejia Individual W-2 Managing EmployeeSr. Operation Manager Jan 1, 2022
Steven Sanzo Individual Corporate OfficerChief Development Officer Jan 4, 2021
Ara Baghdasarian Individual Corporate OfficerChief Executive Officer May 1, 2022
Allen Hassen Individual Corporate OfficerChief Medical Officer Nov 1, 2024
Ellie Zare Individual W-2 Managing EmployeeSr. Program Manager Jan 1, 2022

Owners & managing parties with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1447865415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 436",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914080436",
            "telephone_number": "818-421-0809",
            "fax_number": "562-699-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 E ANAHEIM ST",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133809",
            "telephone_number": "532-218-8181",
            "fax_number": "532-218-8182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-15",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "ZARE",
        "authorized_official_first_name": "ELLIE",
        "authorized_official_title_or_position": "SR. PROGRAM MANGER",
        "authorized_official_telephone_number": "818-650-6700"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.