NPIMap

Organization Active NPI

Altamed Health Services Corp.

Doing business as AltaMed General Pediatrics @ Children's Hospital

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1629283197
Registry record updated Aug 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
FHC71094F Issued in CA
Legal business name
ALTAMED HEALTH SERVICES CORP.
Doing business as
AltaMed General Pediatrics @ Children's Hospital
Practice address
4650 W Sunset Blvd
Los Angeles, CA 90027-6062
Phone
(323) 669-2113
Fax
(323) 906-8003
NPI assigned
May 10, 2007
Last updated
Aug 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2019

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

Authorized official

Name
Robert U. Young, M.D.
Title
VP, Patient Financial Services
Phone
(323) 622-2429

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X FHC71094F CA Primary

Addresses

Primary practice location

4650 W Sunset Blvd
Los Angeles, CA 90027-6062

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (323) 889-7349

Other identifiers 1

IdentifierTypeStateIssuer
FHC71094FMedicaidCA

Other names 1

  • AltaMed General Pediatrics @ Children's Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130807000116 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Los Angeles, CA
O20140702001421 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Los Angeles, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1629283197. Details of each certification follow.

Federally qualified health center certification: CCN 751023

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED GENERAL PEDIATRICS@CHILDREN'S HOSPITAL
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 7, 2013
Last certification
Aug 7, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
4650 W Sunset Blvd
Los Angeles, CA 90027-6062

Federally qualified health center certification: CCN 751082

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP WESTLAKE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 2, 2014
Last certification
Jul 2, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
2100 W 3Rd St
Ste 200
Los Angeles, CA 90057-1993

Other NPIs with the same Medicare PAC ID 22

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

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Altamed Health Ser117 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Maria Grimaldo Individual Corporate DirectorConsumer Board Member Oct 29, 2013
Jose Avalos Individual Corporate DirectorBoard Chairman Jun 28, 2018
Adolfo O Chanez Individual Corporate DirectorBoard Member Feb 25, 2016
Castulo de la Rocha Individual Corporate OfficerPresident & Ceo Mar 1, 1997
Corporate OfficerPresident and Ceo Mar 1, 1997
Marc Victor Individual Corporate DirectorBoard Treasurer Oct 26, 2017
Ricardo Robles Individual Corporate DirectorBoard Vice Chairman Jan 22, 2015
Victor Olmos Individual Corporate DirectorBoard Member Oct 23, 2020
Joseph Gomez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Jose Ubaldo Esparza Individual Corporate OfficerSr VP of Finance, Cfo Jan 20, 1994
Corporate OfficerExecutive VP, Finance & Cfo Jan 20, 1994
Robert Young Individual W-2 Managing EmployeeVP, Patient Financial Services Jan 5, 2009
W-2 Managing EmployeeVP, Patient Financial Services Jan 9, 2009
Nadia Paola Alvarez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Lucy Maria Herrera Individual Corporate DirectorBoard Secretary Oct 25, 2019

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566259200000",
    "number": "1629283197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 CAMFIELD AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900401501",
            "telephone_number": "323-889-7349",
            "fax_number": "323-889-7843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-669-2113",
            "fax_number": "323-906-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2019-08-20",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "U.",
        "authorized_official_title_or_position": "VP, PATIENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "323-622-2429",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "FHC71094F",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71094F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AltaMed General Pediatrics @ Children's Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AltaMed General Pediatrics @ Children's Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.