NPIMap

Organization Active NPI

Complete Care Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Pasadena, CA
National Provider Identifier
1497207229
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC
Practice address
2595 E Washington Blvd Ste 106
Pasadena, CA 91107-1409
Phone
(626) 794-8133
Fax
(626) 794-9163
NPI assigned
Oct 27, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Authorized official

Name
Mr. Yury Akopyan
Title
Ceo
Phone
(323) 266-6700

Specialties & licenses 1

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

Addresses

Primary practice location

2595 E Washington Blvd Ste 106
Pasadena, CA 91107-1409

Mailing address

2595 E Washington Blvd Ste 106
Pasadena, CA 91107-1409
Phone (626) 794-8133

Other names 1

  • Complete Care Community Health Center - Altadena Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170106001606 CA Part A Provider - Federally Qualified Health Center (FQHC) 3779494190 Practice locations: Pasadena, CA

Federally qualified health center certification: CCN 751945

Legal name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC
Doing business as
COMPLETE CARE COMMUNITY HEALTH CENTER - ALTADENA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 12, 2016
Last certification
Dec 12, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 14, 2003 in CA
Enrollment address
2595 E Washington Blvd
Ste 106
Pasadena, CA 91107-1409

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Complete Care Community Health Center Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Ownership & related parties

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.

NameRoleSinceShare
Inessa Miretsky Individual Corporate DirectorBoard Member Apr 17, 2016
Yury Akopyan Individual Corporate OfficerCeo Nov 2, 2012
W-2 Managing EmployeeCeo Nov 2, 2012
Dina E Belensky Individual Corporate DirectorBoard Chair Sep 12, 2006
Joyce Reese Individual Corporate DirectorBoard Member Mar 20, 2016
Complete Care Community Health Center, Inc Organization, Los Angeles, CA Corporation, Non-profit Operational/Managerial Control Apr 1, 2016 100%
Mariella Menbreno Individual Corporate DirectorBoard Member Sep 27, 2020
Viktoriya Makerova Individual Corporate DirectorBoard Member Jun 13, 2012
Sonia Henriquez Individual Corporate DirectorBoard Member Nov 25, 2014
Anthony L Willis Individual Corporate DirectorBoard Member May 9, 2012
Marisol Jimenez Individual Corporate DirectorBoard Member Sep 27, 2020
Ernesto Haro Individual Corporate DirectorBoard Member Jan 14, 2014
Wendy Navarrete Individual Corporate DirectorBoard Member Nov 25, 2014

Owners & managing parties with NPI records 11

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Complete Care Community Health Center - Monterey ParkMonterey Park, CA, CCN 921927 Federally qualified health center Operational/Managerial Control Oct 14, 2003
Complete Care Community Health Center - Monterey ParkMonterey Park, CA, CCN 921928 Federally qualified health center Operational/Managerial Control Oct 14, 2003
Complete Care Community Health Center - Huntington ParkHuntington Park, CA, CCN 921925 Federally qualified health center Operational/Managerial Control Oct 14, 2003

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1497207229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 E WASHINGTON BLVD STE 106",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071409",
            "telephone_number": "626-794-8133",
            "fax_number": "626-794-9163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2595 E WASHINGTON BLVD STE 106",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911071409",
            "telephone_number": "626-794-8133",
            "fax_number": "626-794-9163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE CARE COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "AKOPYAN",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-266-6700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Care Community Health Center - Altadena",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Complete Care Community Health Center - Altadena",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pasadena, CA

Sources for this page

Verify at the official NPI Registry.