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Organization Active NPI

St. John's Community Health

  • Community Health Clinic/Center
  • Indio, CA
National Provider Identifier
1609624980
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
ST. JOHN'S COMMUNITY HEALTH
Practice address
82025 Highway 111
Unit 101
Indio, CA 92201-5686
Phone
(323) 541-1600
NPI assigned
May 10, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Authorized official

Name
Mrs. Maria Socorro Genie
Title
Chief Administrative Officer
Phone
(323) 541-1600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Supports Brokerage Agency 251X00000X
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

82025 Highway 111
Unit 101
Indio, CA 92201-5686

Mailing address

808 W 58TH St
Los Angeles, CA 90037-3632
Phone (323) 541-1600

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL HIE Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040722001434 CA Part B Supplier - Clinic/Group Practice 2961482690 Receives reassigned benefits from 440 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Lynwood, CA; San Bernardino, CA; San Jacinto, CA; Compton, CA; Indio, CA
O20250128001466 CA Part A Provider - Federally Qualified Health Center (FQHC) 2961482690 Practice locations: Indio, CA

Federally qualified health center certification: CCN A01921

Legal name
ST. JOHN'S COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 26, 2024
Last certification
Dec 26, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
82025 US Highway 111
Unit 101
Indio, CA 92201-5686

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
St John's Well Child and Family Center35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Locations

1500 N Waterman Ave
Sn Bernrdno, CA 92404
Phone (909) 381-1591

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
William E Dawe Individual Corporate DirectorBoard Treasurer Aug 10, 2002
Joanna Choi Individual Corporate DirectorBoard Member Jan 1, 2014
Elizabeth M Meisler Individual Corporate OfficerCfo Sep 14, 2009
Lilia Garcia Individual Corporate DirectorBoard Chair Jul 5, 2002
James J Mangia Individual Corporate OfficerCeo Jan 10, 1993
W-2 Managing EmployeeCeo Jan 10, 1993
Ernesto Barahona Individual Corporate OfficerCoo Aug 12, 2016
Sushant Bandarpalle Individual Corporate OfficerChief Medical Officer Jun 27, 2023
Martha Ortiz Individual Corporate DirectorBoard Member Jun 6, 2002

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1715299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1609624980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W 58TH ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900373632",
            "telephone_number": "323-541-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82025 HIGHWAY 111",
            "address_2": "UNIT 101",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922015686",
            "telephone_number": "323-541-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-10",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "GENIE",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "SOCORRO",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "323-541-1600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "HIE",
            "affiliation": "N",
            "endpointDescription": "FHIR URL",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "82025 Highway 111",
            "address_2": "101",
            "city": "Indio",
            "state": "CA",
            "country_code": "US",
            "postal_code": "922015686",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Indio, CA

Sources for this page

Verify at the official NPI Registry.