NPIMap

Organization Active NPI

Benevolence Industries Incorporated

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1578763207
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550001971 Issued in CA
Legal business name
BENEVOLENCE INDUSTRIES INCORPORATED
Practice address
3631 Crenshaw Blvd
109
Los Angeles, CA 90016-4869
Phone
(323) 732-0100
Fax
(323) 732-0104
NPI assigned
Jul 20, 2007
Last updated
Jan 21, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
CRENSHAW COMMUNITY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Authorized official

Name
Kwabena Obeng
Title
Chief Executive Officer
Phone
(310) 800-7963

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X 550001971 CA Primary

Addresses

Primary practice location

3631 Crenshaw Blvd
109
Los Angeles, CA 90016-4869

Mailing address

1010 Crenshaw Blvd Ste 100
Torrance, CA 90501-2055
Phone (323) 732-0100

Other identifiers 1

IdentifierTypeStateIssuer
1578763207MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070910000638 CA Part B Supplier - Clinic/Group Practice 3870686611 Receives reassigned benefits from 13 practitioners
8 other NPIs on this enrollment
Practice locations: Sylmar, CA; Orange, CA; Los Angeles, CA; Long Beach, CA; Compton, CA; Anaheim, CA
O20130412000597 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870686611 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578763207. Details of each certification follow.

Federally qualified health center certification: CCN 751011

Legal name
BENEVOLENCE INDUSTRIES INCORPORATED
Doing business as
CRENSHAW COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 12, 2013
Last certification
Apr 12, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 2007 in CA
Enrollment address
3631 Crenshaw Blvd 109
Los Angeles, CA 90016-4869

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 8

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

National Provider Directory

National Provider Directory
Part of
Benevolence Industries

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BAFBCA

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Allison Norton Individual Corporate Director Aug 1, 2011
Salisu a Aikoye Individual Corporate Director Aug 1, 2011
Michael Tetteh Individual Corporate Director Aug 1, 2011
Ernestine Smith Individual Corporate Director Aug 1, 2011
Kwabena Obeng Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2012
Corporate OfficerChief Executive Officer Jun 1, 2012 10%
W-2 Managing EmployeeChief Executive Officer Jun 1, 2012 100%
Edward Frimpong Individual Corporate Director Aug 1, 2011
Rebekah Jennings Individual Corporate Director Aug 1, 2011
Emmanuel Freduah Agyemang Individual W-2 Managing EmployeeCfo Jan 1, 2017 1%
Thomas Adueni Individual Corporate Director Aug 1, 2011

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 4

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

FacilityTypeRoleSince
Benevolence Health CenterAnaheim, CA, CCN 921187 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 8, 2014
Jul 8, 2014
Benevolence Health CenterOrange, CA, CCN 921188 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 12, 2014
May 12, 2014
Benevolence Health CenterLong Beach, CA, CCN 921189 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Feb 3, 2014
Feb 3, 2014
Benevolence Health CenterLos Angeles, CA, CCN A01015 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 May 5, 2014
May 5, 2014

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1184889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611187200000",
    "number": "1578763207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 CRENSHAW BLVD STE 100",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905012055",
            "telephone_number": "323-732-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3631 CRENSHAW BLVD",
            "address_2": "109",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900164869",
            "telephone_number": "323-732-0100",
            "fax_number": "323-732-0104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEVOLENCE INDUSTRIES INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRENSHAW COMMUNITY CLINIC",
        "enumeration_date": "2007-07-20",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A",
        "authorized_official_last_name": "OBENG",
        "authorized_official_first_name": "KWABENA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "310-800-7963"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550001971",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578763207",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.