NPIMap

Organization Active NPI

Pih Health Good Samaritan Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
National Provider Identifier
1508859323
Registry record updated Jul 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
930000071 Issued in CA
Legal business name
PIH HEALTH GOOD SAMARITAN HOSPITAL
Practice address
1225 Wilshire Blvd
Los Angeles, CA 90017-1901
Phone
(213) 977-2121
Fax
(213) 202-7118
NPI assigned
Aug 26, 2005
Last updated
Jul 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2021

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

Authorized official

Name
Susanne (Sue) R Ponce (Aka Carlson)
Title
Special Projects
Phone
(562) 698-0811

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 930000071 CA Primary

Addresses

Primary practice location

1225 Wilshire Blvd
Los Angeles, CA 90017-1901

Mailing address

1225 Wilshire Blvd
Los Angeles, CA 90017-1901
Phone (213) 977-2121

Other identifiers 1

IdentifierTypeStateIssuer
HSC30471FMedicaidCA

Other names 1

  • Good Samaritan Hospital Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101022000694 CA Part A Provider - Hospital 4880887884 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508859323. Details of each certification follow.

Hospital certification: CCN 050471

Legal name
PIH HEALTH GOOD SAMARITAN HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 22, 2019
Beds
408 (380 certified)
Ownership / control type
Private (for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 9, 1994 in CA
Enrollment address
1245 Wilshire Blvd
Ste 200
Los Angeles, CA 90017-4812
Other Hospital Practice Location
Hospital subgroups
Acute care, Rehabilitation unit, Other

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Pih Health Good Samaritan HospitalCCN 050471 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory

Locations

1300 W 7th St
San Pedro, CA 90732
Phone (310) 514-5350

18321 Ventura Blvd
Ste 150
Tarzana, CA 91356
Phone (818) 776-0660

10123 SE Market St
Portland, OR 97216
Phone (503) 251-6355

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Melanie Catherine Batiste Individual Corporate DirectorBoard MBR-Shared Governance Oct 21, 2021
Vidhyashankaran Mahalingamshivaraman Individual Corporate OfficerChiel Financial Officer-Shared Gov. Apr 12, 2021
W-2 Managing EmployeeChief Financial Officer Apr 12, 2021
Operational/Managerial ControlChief Financial Officer Apr 12, 2021
J Richard Atwood Individual Corporate DirectorBoard MBR-Shared Governance Apr 25, 2005
Robert Maloney Individual Corporate DirectorBoard MBR-Shared Governance Oct 1, 2021
Charlotte a Weaver Individual Corporate DirectorBoard MBR-Shared Governance Oct 10, 2016
Jane B Dicus Individual Corporate DirectorBoard MBR-Shared Governance Feb 12, 2007
Susanne R Ponce Individual W-2 Managing EmployeeSpecial Projects May 4, 1983
Hamilton J Hamar Individual Corporate DirectorBoard MBR-Shared Governance Oct 10, 2016
Peggy a Chulack Individual Corporate OfficerChief Administrative Officer Jul 6, 2004
Blayne H Cutler Individual Corporate DirectorBoard MBR-Shared Governance Oct 9, 2017
Paula K Cowan Individual Corporate DirectorBoard MBR-Shared Governance Mar 14, 2011
Peter P Greaney Individual Corporate DirectorBoard MBR-Shared Governance Nov 13, 2018
Noel Patrick Coppinger Individual W-2 Managing EmployeeVP Revenue Cycle Oct 18, 2019
Operational/Managerial ControlVP Revenue Cycle Oct 18, 2019
Patrick L Monroe Individual Corporate DirectorBoard MBR-Shared Governance Oct 10, 2016
James R West Individual Corporate OfficerPresident/Ceo-Shared Governance Oct 1, 2004
W-2 Managing EmployeePresident/Ceo Shared Governance Oct 1, 2004
Operational/Managerial ControlPresident/Ceo Shared Governance Jan 1, 2020
Wesley R Heartfield Individual Corporate DirectorBoard Member Mar 26, 2021
Pih Health Inc Organization, Whittier, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Nov 6, 2019 100%
Operational/Managerial Control Jan 1, 2020 100%
Kenton C Woods Individual Corporate DirectorBoard MBR-Shared Governance Feb 28, 2005
Paul a Treinen Individual Corporate DirectorBoard Member Nov 12, 2019
Alex F Alvarez Individual Corporate DirectorBoard MBR-Shared Governance Oct 9, 2017

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Pih Health Good Samaritan HospitalLos Angeles, CA, CCN 555927 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control
Adp of the SNF		 Jan 1, 2020
Jan 1, 2020
Feb 18, 2025

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 443

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.

View all 443

Affiliated clinicians 325

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

View all 325

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627257600000",
    "number": "1508859323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171901",
            "telephone_number": "213-977-2121",
            "fax_number": "213-202-7118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171901",
            "telephone_number": "213-977-2121",
            "fax_number": "213-202-7118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIH HEALTH GOOD SAMARITAN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-26",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A",
        "authorized_official_last_name": "PONCE (AKA CARLSON)",
        "authorized_official_first_name": "SUSANNE (SUE)",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SPECIAL PROJECTS",
        "authorized_official_telephone_number": "562-698-0811"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "930000071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSC30471F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Samaritan Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.