NPIMap

Organization Active NPI

Providence Health System - Southern California

Doing business as Providence Little Company of Mary Medical Center San Pedro OBHC

  • General Acute Care Hospital
  • San Pedro, CA
National Provider Identifier
1497241541
Registry record updated May 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
930000142 Issued in CA
Legal business name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Doing business as
Providence Little Company of Mary Medical Center San Pedro OBHC
Practice address
1386 W 7TH St # a
San Pedro, CA 90732-3517
Phone
(310) 241-4330
Fax
(310) 241-4342
NPI assigned
Jul 2, 2018
Last updated
May 9, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORINAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2025

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

Authorized official

Name
Donald W Anderson Jr.
Title
Assistant Secretary Enrollments
Phone
(425) 358-9786

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 930000142 CA Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

1386 W 7TH St # a
San Pedro, CA 90732-3517

Mailing address

PO Box 541024
Los Angeles, CA 90054-1024
Phone (310) 303-7496

Other names 1

  • Providence Little Company of Mary Medical Center San Pedro OBHC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050726001252 CA Part A Provider - Hospital 0042248536 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Pedro, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497241541. Details of each certification follow.

Hospital certification: CCN 050078

Legal name
PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA
Doing business as
PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 9, 2021
Beds
387 (259 certified)
Ownership / control type
Private (not for profit)
Most recent change of ownership
Nov 1, 2005 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Dec 5, 1903 in CA
Enrollment address
1300 W 7TH St
San Pedro, CA 90732-3505
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Providence Little Co of Mary Med Ctr San PedroCCN 050078 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Little Company of Mary - San Pedro8 organizations share this tax ID, including this one
Part of
Little Company of Mary - San Pedro

Other organizations with this tax ID 7

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

Locations

1386 W 7th St
#A
San Pedro, CA 90732
Phone (310) 241-4330

Ownership & related parties

All disclosed owners & managing parties 25

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

NameRoleSinceShare
Diane L Hejna Individual Corporate DirectorBoard Member Jul 1, 2016
Richard S Blair Individual Corporate DirectorBoard Member Jul 1, 2016
Marvin O'Quinn Individual Corporate DirectorDirector Jan 1, 2024
Linda Buck Individual Corporate DirectorBoard Member Jan 1, 2025
Jason Kell Individual W-2 Managing EmployeeFinancial Executive Jan 1, 2026
Providence Health & Services - Washington Organization, Renton, WA Corporation, Non-profit Operational/Managerial Control Jun 3, 2009
Providence Health System-Southern California Organization, Renton, WA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 3, 2009
Mary E Lyons Individual Corporate DirectorBoard Member Jul 1, 2016
Michael Ricks Individual W-2 Managing EmployeeCeo Nov 5, 2023
Phyllis M Hughes Individual Corporate DirectorBoard Member Jan 1, 2014
Rogelio Riojas Individual Corporate DirectorBoard Member Jan 1, 2025
James Martin Individual Corporate OfficerAuthorized Official Jan 13, 2023
Charles Wallace Sorenson Individual Corporate DirectorBoard Member Jan 1, 2019
Donald Wayne Anderson Individual Corporate OfficerAssistant Secretary of Enrollments Dec 20, 2016
Gregory David Hoffman Individual Corporate OfficerPresident/Ceo & Treasurer Oct 1, 2020
Isiaah D Crawford Individual Corporate DirectorBoard Member Feb 1, 2012
Donna Markham Individual Corporate DirectorDirector Jan 1, 2024
Michael W Murphy Individual Corporate DirectorBoard Member Jan 1, 2020
Providence Health & Services Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016
Mary Beth Kingston Individual Corporate DirectorBoard Member Sep 1, 2022
Eric D Sprunk Individual Corporate DirectorBoard Member Jan 1, 2022
Anna R Newsom Individual Corporate OfficerCorporate Secretary May 13, 2022
Darryl Elmouchi Individual Corporate OfficerPresident/Ceo Apr 1, 2025
Karin Dufault Individual Corporate DirectorBoard Member Jan 1, 2025
Providence St. Joseph Health Organization, Renton, WA Corporation, Non-profit Other Jul 1, 2016

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 261

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 261

NPI Registry JSON

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746748800000",
    "number": "1497241541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 541024",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900541024",
            "telephone_number": "310-303-7496",
            "fax_number": "310-303-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1386 W 7TH ST # A",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323517",
            "telephone_number": "310-241-4330",
            "fax_number": "310-241-4342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORINA",
        "enumeration_date": "2018-07-02",
        "last_updated": "2025-05-09",
        "certification_date": "2025-05-09",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "930000142",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Little Company of Mary Medical Center San Pedro OBHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence Little Company of Mary Medical Center San Pedro OBHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Pedro, CA

Sources for this page

Verify at the official NPI Registry.