NPIMap

Organization Active NPI

White Memorial Community Health Center

  • Dentist
  • Los Angeles, CA
National Provider Identifier
1619456928
Registry record updated Feb 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
WHITE MEMORIAL COMMUNITY HEALTH CENTER
Practice address
1828 E Cesar E Chavez Ave Ste 4100
Los Angeles, CA 90033-2400
Phone
(323) 987-1200
Fax
(323) 987-1212
NPI assigned
Aug 8, 2018
Last updated
Feb 5, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
WHITE MEMORIAL COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 5, 2020

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

Authorized official

Name
Carl Edward Coan
Title
Ceo
Phone
(323) 987-1222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

1828 E Cesar E Chavez Ave Ste 4100
Los Angeles, CA 90033-2400

Mailing address

1828 E Cesar E Chavez Ave Ste 4100
Los Angeles, CA 90033-2400
Phone (323) 987-1200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190101000001 CA Part A Provider - Federally Qualified Health Center (FQHC) 7315218260 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619456928. Details of each certification follow.

Federally qualified health center certification: CCN 921110

Legal name
WHITE MEMORIAL COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 26, 2018
Last certification
Dec 26, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 23, 2014 in CA
Enrollment address
1828 E Cesar E Chavez Ave
Ste 4100
Los Angeles, CA 90033-2400

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
White Memorial Community Health Center3 organizations share this tax ID, including this one
Part of
White Memorial Community Health Center

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the 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
Joselyn Rivas Individual Corporate DirectorBoard Member Jan 5, 2017
George Ramirez Individual Corporate DirectorBoard Member Jan 13, 2015
Norma Osorio Individual Corporate DirectorBoard Member Jan 13, 2015
Elizabeth Aleman Individual Corporate Director Jan 5, 2017
Grace K Floutsis Individual Corporate OfficerCeo/Cmo Dec 2, 2019
W-2 Managing Employee Nov 1, 2015
Ergueen Herrera Individual Corporate Director Jan 13, 2015
John Raffoul Individual Corporate DirectorBoard Member Jan 13, 2015
White Memorial Community Health Center Organization, Los Angeles, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 13, 2015
Yolanda T Rangel Individual Corporate DirectorBoard Member Jan 5, 2017
David C Lizarraga Individual Corporate DirectorBoard Member Jan 13, 2015
Ana I Grande Individual Corporate DirectorBoard Member Dec 6, 2018

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
White Memorial Community Health CenterLos Angeles, CA, CCN 921063 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 13, 2015
White Memorial Community Health CenterLos Angeles, CA, CCN A01875 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 13, 2015
White Memorial Community Health CenterLos Angeles, CA, CCN A11000 Federally qualified health center Other Jan 1, 2017

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 2

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

NPI Registry JSON

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

{
    "created_epoch": "1533686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580860800000",
    "number": "1619456928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 E CESAR E CHAVEZ AVE STE 4100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332400",
            "telephone_number": "323-987-1200",
            "fax_number": "323-987-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1828 E CESAR E CHAVEZ AVE STE 4100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332400",
            "telephone_number": "323-987-1200",
            "fax_number": "323-987-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MEMORIAL COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITE MEMORIAL COMMUNITY HEALTH CENTER",
        "enumeration_date": "2018-08-08",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A",
        "authorized_official_last_name": "COAN",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "323-987-1222"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.