NPIMap

Organization Active NPI

Comprehensive Community Health Centers Inc

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1679553192
Registry record updated Feb 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
COMPREHENSIVE COMMUNITY HEALTH CENTERS INC
Practice address
1704 Colorado Blvd
Los Angeles, CA 90041-1338
Phone
(323) 256-4116
Fax
(323) 478-9454
NPI assigned
Jan 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2022

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

Authorized official

Name
Flora Poladyan
Title
Coo
Phone
(323) 454-4481

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

1704 Colorado Blvd
Los Angeles, CA 90041-1338

Mailing address

801 S Chevy Chase Dr
20
Glendale, CA 91205-4431
Phone (323) 256-4116

Other identifiers 1

IdentifierTypeStateIssuer
FHC71014FMedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000548 CA Part B Supplier - Clinic/Group Practice 9638082456 Receives reassigned benefits from 66 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Arleta, CA; Glendale, CA; Los Angeles, CA; N Hollywood, CA; Sunland, CA
O20110215000119 CA Part A Provider - Federally Qualified Health Center (FQHC) 9638082456 Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN 551968

Legal name
COMPREHENSIVE COMMUNITY HEALTH CENTERS INC
Doing business as
COMPREHENSIVE COMMUNITY HEALTH CENTERS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 2004
Last certification
Jun 7, 2004
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 13, 2002 in CA
Enrollment address
1704 Colorado Blvd
Los Angeles, CA 90041-1338

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 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1015150Comprehensive Community Health Centers Inc1704 Colorado Blvd, Los Angeles, CA 90041Certificate of waiverJul 23, 2027

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
Jean-Pierre E Antaki Individual Corporate DirectorMember of Board of Directors Sep 14, 2009
Jennifer L Smith Individual Corporate OfficerCheif Administrative Officer Jan 1, 2022
David G Lontok Individual Corporate OfficerCeo Mar 1, 2018
W-2 Managing EmployeeCeo May 4, 2020
Odet Mkrtchian Individual Corporate DirectorMember of Board of Directors Jan 15, 2018
Armen Der Abrahamian Individual Corporate DirectorMember of Board of Directors Mar 13, 2017
Genesis Nungaray Individual Corporate DirectorBoard Member Oct 11, 2021
Nancy Guillen Individual Corporate DirectorMember of Board of Directors Nov 11, 2013
Ara Tavitian Individual Corporate DirectorMember of Board of Directors Mar 12, 2018
Flora Poladyan Individual Corporate OfficerChief Operations Officer Oct 24, 2002
Rika Okazaki Individual Corporate DirectorBoard Member Aug 9, 2021
Greg Krikorian Individual Corporate DirectorMember of Board of Directors Apr 22, 2013

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 9

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": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1679553192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S CHEVY CHASE DR",
            "address_2": "20",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912054431",
            "telephone_number": "323-256-4116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 COLORADO BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900411338",
            "telephone_number": "323-256-4116",
            "fax_number": "323-478-9454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "POLADYAN",
        "authorized_official_first_name": "FLORA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "323-454-4481"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71014F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.