NPIMap

Organization Active NPI

Share Our Selves Corporation

  • Federally Qualified Health Center (FQHC)
  • Costa Mesa, CA
National Provider Identifier
1508073685
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SHARE OUR SELVES CORPORATION
Practice address
1550 Superior Ave
Costa Mesa, CA 92627-3653
Phone
(949) 270-2100
Fax
(949) 515-5804
NPI assigned
May 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Authorized official

Name
Christy Ward
Title
Ceo
Phone
(949) 536-3927

Specialties & licenses 1

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

Addresses

Primary practice location

1550 Superior Ave
Costa Mesa, CA 92627-3653

Mailing address

PO Box 10159
Costa Mesa, CA 92627-0050
Phone (949) 270-2100

Other identifiers 1

IdentifierTypeStateIssuer
CMM70513FOtherCAMEDI-CAL

Other names 1

  • Share Our Selves Community Health 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
O20110825000722 CA Part B Supplier - Clinic/Group Practice 4789854993 Receives reassigned benefits from 42 practitioners
6 other NPIs on this enrollment
Practice locations: Costa Mesa, CA; Mission Viejo, CA; Newport Beach, CA; Santa Ana, CA; Anaheim, CA
O20130819000231 CA Part A Provider - Federally Qualified Health Center (FQHC) 4789854993 Practice locations: Costa Mesa, CA

Federally qualified health center certification: CCN 751028

Legal name
SHARE OUR SELVES CORPORATION
Doing business as
SHARE OUR SELVES COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 19, 2013
Last certification
Aug 19, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1550 Superior Ave
Costa Mesa, CA 92627-3653

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Locations

2045 Meyer Pl
Unit C
Costa Mesa, CA 92627
Phone (949) 515-6725

1014 N Broadway
Santa Ana, CA 92701
Phone (949) 270-2132

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Daniel Cortes Individual Corporate Director May 13, 2024
Nicole Machado Individual Corporate Director Apr 11, 2022
W-2 Managing Employee Apr 11, 2022
Itzel Aguilar-Romero Individual Corporate Director Sep 5, 2023
Rosario Lizbeth Galeas Individual Corporate Director Dec 13, 2017
Marc Harper Individual Corporate Director Jun 13, 2016
Allyson M Brooks Individual Corporate Director Apr 9, 2019
Maria Gracita Dacosta-Iyer Individual Corporate Director Dec 9, 2024
Ernest W Klatte Individual Corporate Director Jun 6, 2013
Martha Rivera Individual Corporate Director Apr 9, 2019
Susan Epstein Individual Corporate Director Jul 8, 2013
David Snow Individual Corporate Director Nov 13, 2017
John Yoo Individual Corporate Director Nov 13, 2017
Anna C Solt Individual Corporate Director Apr 13, 2020
Christy Ward Individual Corporate OfficerCeo Sep 3, 2019
W-2 Managing Employee Sep 3, 2019

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 3

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

FacilityTypeRoleSince
Share Our Selves Children and Family Health CenterNewport Beach, CA, CCN 751856 Federally qualified health center Other (100%) Feb 1, 2016
Sos-El Sol Wellness CenterSanta Ana, CA, CCN 751858 Federally qualified health center Other (100%) Feb 2, 2016
Share OurselvesCosta Mesa, CA, CCN A01907 Federally qualified health center Other (100%) Sep 6, 2023

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601596800000",
    "number": "1508073685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10159",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926270050",
            "telephone_number": "949-270-2100",
            "fax_number": "949-515-5804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 SUPERIOR AVE",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273653",
            "telephone_number": "949-270-2100",
            "fax_number": "949-515-5804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHARE OUR SELVES CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-17",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A",
        "authorized_official_last_name": "WARD",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-536-3927"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "CMM70513F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Share Our Selves Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.