NPIMap

Organization Active NPI

The Los Angeles Free Clinic

Doing business as Saban Community Clinic

  • Community/Retail Pharmacy
  • Los Angeles, CA
National Provider Identifier
1558740852
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
53430 Issued in CA
Legal business name
THE LOS ANGELES FREE CLINIC
Doing business as
Saban Community Clinic
Practice address
5205 Melrose Ave
Los Angeles, CA 90038-3144
Phone
(323) 337-1815
NPI assigned
May 20, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Authorized official

Name
Muriel Nouwezem
Title
Chief Executive Officer
Phone
(323) 337-1707

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X
Community/Retail Pharmacy 3336C0003X 53430 CA Primary

Addresses

Primary practice location

5205 Melrose Ave
Los Angeles, CA 90038-3144

Mailing address

8405 Beverly Blvd
Los Angeles, CA 90048-3401
Phone (323) 330-1651

Other names 1

  • Saban Community Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20240509002474 CA Part B Supplier - Pharmacy 5395886311 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA
O20251222000810 CA DME Supplier - Pharmacy 5395886311 Practice locations: Los Angeles, CA
O20260316000821 CA Part B Supplier - Mass Immunization (Roster Biller Only) 5395886311 Practice locations: Los Angeles, CA

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Saban Community Clinic - Melrose5205 Melrose Ave, Los Angeles, CA 90038-3144(323) 653-1990 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 1, 2014

National Provider Directory

National Provider Directory
Tax ID family
The Los Angeles Free Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Saban Community ClinicLos Angeles, CA, CCN 551181 Federally qualified health center Other (100%) Dec 14, 1967
Saban Community Clinic the Center at Blessed SacramentLos Angeles, CA, CCN 921931 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 28, 2020
Saban Community Clinic - the VirgilLos Angeles, CA, CCN 921932 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 13, 2020

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 61

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 61

NPI Registry JSON

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

{
    "created_epoch": "1432080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1558740852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8405 BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900483401",
            "telephone_number": "323-330-1651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5205 MELROSE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900383144",
            "telephone_number": "323-337-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LOS ANGELES FREE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-20",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-23",
        "status": "A",
        "authorized_official_last_name": "NOUWEZEM",
        "authorized_official_first_name": "MURIEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "323-337-1707"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "53430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Saban Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Saban Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.