NPIMap

Organization Active NPI

Mission City Community Network, Inc.

  • Primary Care Clinic/Center
  • Pomona, CA
National Provider Identifier
1609151273
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
960000465 Issued in CA
Legal business name
MISSION CITY COMMUNITY NETWORK, INC.
Practice address
1818 N Orange Grove Ave
205
Pomona, CA 91767-3028
Phone
(818) 895-3100
Fax
(818) 892-4651
NPI assigned
Oct 14, 2011
Last updated
Oct 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Authorized official

Name
Nik Gupta
Title
Chief Executive Officer
Phone
(818) 895-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 960000465 CA Primary

Addresses

Primary practice location

1818 N Orange Grove Ave
205
Pomona, CA 91767-3028

Mailing address

15206 Parthenia St
North Hills, CA 91343-5305
Phone (818) 895-3100

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040204000544 CA Part B Supplier - Clinic/Group Practice 1658264684 Receives reassigned benefits from 152 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Hills, CA; Northridge, CA; Victorville, CA
O20150527002325 CA Part A Provider - Federally Qualified Health Center (FQHC) 1658264684 Practice locations: Pomona, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609151273. Details of each certification follow.

Federally qualified health center certification: CCN 751171

Legal name
MISSION CITY COMMUNITY NETWORK, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 27, 2015
Last certification
May 27, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 6, 1989 in CA
Enrollment address
1818 N Orange Grove Ave
Ste 205
Pomona, CA 91767-3028

Other NPIs with the same Medicare PAC ID 18

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

View all 18

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Maria Chaudhry Individual Corporate DirectorBoard Member Dec 1, 2012
Nik Gupta Individual Corporate OfficerCeo Mar 16, 2001
Corporate DirectorCeo Jul 1, 2009
W-2 Managing EmployeeCeo Jul 1, 2009
Frank Gonzales Individual Corporate DirectorBoard Member Jun 13, 2017
Aida Vlught Individual Corporate DirectorBoard Member Jul 1, 2000
Norma J Solis Individual Corporate DirectorBoard Member Jun 30, 2021
Sammy Riley Individual Corporate DirectorBoard Member Feb 23, 2021
Mark Berry Individual Corporate DirectorBoard Member Aug 19, 2017
Adriana Guzman Individual Corporate DirectorBoard Member Mar 17, 2014
Magdalena Almira Individual Corporate OfficerCfo - Chief Financial Officer Feb 20, 2007
Rosalind Scarbrough Individual Corporate DirectorBoard Member Feb 23, 2021
Derek Biesheuvel Individual Corporate DirectorBoard Member Mar 14, 2014

NPI Registry JSON

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318550400000",
    "number": "1609151273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15206 PARTHENIA ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435305",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 N ORANGE GROVE AVE",
            "address_2": "205",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673028",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-14",
        "last_updated": "2011-10-14",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "NIK",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "818-895-3100"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "960000465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.