NPIMap

Organization Active NPI

Mission City Community Network, Inc.

  • Community Health Clinic/Center
  • North Hills, CA
National Provider Identifier
1710370747
Registry record updated Jul 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
MISSION CITY COMMUNITY NETWORK, INC.
Doing business as
Mission City Community Network Inc.
Practice address
8527 Sepulveda Blvd
North Hills, CA 91343-5824
Phone
(818) 895-3100
Fax
(818) 893-9464
NPI assigned
Mar 16, 2015
Last updated
Jul 18, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
MISSION CITY COMMUNITY NETWORK, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 18, 2017

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

Authorized official

Name
Nik Gupta
Title
Ceo
Phone
(818) 895-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

8527 Sepulveda Blvd
North Hills, CA 91343-5824

Mailing address

8527 Sepulveda Blvd
North Hills, CA 91343-5824
Phone (818) 895-3100

Other names 1

  • Mission City Community Network Inc. Doing business as

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
O20170322002328 CA Part A Provider - Federally Qualified Health Center (FQHC) 1658264684 Practice locations: North Hills, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710370747. Details of each certification follow.

Federally qualified health center certification: CCN 751952

Legal name
MISSION CITY COMMUNITY NETWORK, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 21, 2017
Last certification
Feb 21, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 6, 1989 in CA
Enrollment address
8527 Sepulveda Blvd
North Hills, CA 91343-5824

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
Tax ID family
Mission City Community NTWK18 organizations share this tax ID, including this one
Part of
Mission City Community NTWK

Other organizations with this tax ID 17

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

View all 17

Locations

9808 Venice Blvd
Ste 404
Culver City, CA 90232
Phone (310) 556-0702

501 E Hardy St
Ste 100
Inglewood, CA 90301
Phone (310) 680-4500

501 E Hardy St
Ste 110
Inglewood, CA 90301
Phone (310) 412-8941

5800 King Ave
Maywood, CA 90270
Phone (323) 210-1412

513 E Lime Ave
Monrovia, CA 91016
Phone 8188953100602

513 E Lime Ave
Ste 103
Monrovia, CA 91016
Phone (626) 357-2605

15210 Parthenia St
North Hills, CA 91343
Phone (801) 895-3100

845 E Arrow Hwy
Pomona, CA 91767
Phone (909) 222-2617

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 Officer 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 17, 2014

Practitioners & affiliated clinicians

Practitioners 150

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 150

NPI Registry JSON

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

{
    "created_epoch": "1426464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500336000000",
    "number": "1710370747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8527 SEPULVEDA BLVD",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435824",
            "telephone_number": "818-895-3100",
            "fax_number": "818-893-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8527 SEPULVEDA BLVD",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435824",
            "telephone_number": "818-895-3100",
            "fax_number": "818-893-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "enumeration_date": "2015-03-16",
        "last_updated": "2017-07-18",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "NIK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-895-3100"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mission City Community Network Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Hills, CA

Sources for this page

Verify at the official NPI Registry.