NPIMap

Organization Active NPI

Pediatric and Family Medical Center

Doing business as Eisner Pediatric and Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1720468804
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEDIATRIC AND FAMILY MEDICAL CENTER
Doing business as
Eisner Pediatric and Family Medical Center
Practice address
1513 S Grand Ave
Suite 220 & 250
Los Angeles, CA 90015-3070
Phone
(213) 747-5542
NPI assigned
Jun 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

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

Authorized official

Name
Monica McCarthy
Title
Sr VP, Coo & Interim-Ceo
Phone
(213) 747-5542

Specialties & licenses 1

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

Addresses

Primary practice location

1513 S Grand Ave
Suite 220 & 250
Los Angeles, CA 90015-3070

Mailing address

1513 S Grand Ave
Suite 220 & 250
Los Angeles, CA 90015-3070
Phone (213) 747-5542

Other names 1

  • Eisner Pediatric and Family Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160121000064 CA Part A Provider - Federally Qualified Health Center (FQHC) 1557301678 Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN 751831

Legal name
PEDIATRIC AND FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 2015
Last certification
Dec 8, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1920 in CA
Enrollment address
1513 S Grand Ave
Suite 220 & 250
Los Angeles, CA 90015-3075

Other NPIs with the same Medicare PAC ID 4

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

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
05D2104570Eisner Pediatric & Family Medical Center - Women's1513 S Grand Ave Ste 250, Los Angeles, CA 90015Certificate of waiverNov 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Family Medical C13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1513 S Grand Ave
Ste 220
Los Angeles, CA 90015

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Sergey Navolnev Individual Corporate OfficerChief Financial Officer Jan 1, 2024
W-2 Managing EmployeeChief Financial Officer Jan 1, 2024
Irma Avila Individual Corporate DirectorBoard Member Jul 3, 2011
Monica Gutierrez-McCarthy Individual Corporate OfficerPresident & Ceo Mar 29, 2021
W-2 Managing EmployeePresident & Ceo Mar 29, 2021
Tyler Vogler Individual Corporate OfficerChief Operations Officer Feb 3, 2025
W-2 Managing EmployeeChief Operations Officer Feb 3, 2025
Martine Singer Individual Corporate DirectorBoard Member Nov 1, 2018
Edward Matthews Individual Corporate DirectorVice-Chair Jul 5, 2011
Stan Berkman Individual Corporate DirectorBoard Member May 3, 2015
Christopher Isola Individual Corporate DirectorBoard of Directors Member Jun 8, 2023
Alejandra Rosas Rodriguez Individual Corporate DirectorBoard Member Jul 3, 2011
Rupert Grant Individual Corporate DirectorBoard Member Jul 3, 2014
Kevin J Rossi Individual Corporate DirectorChair Jul 3, 2011
Ian Weiner Individual Corporate DirectorBoard Member Jul 3, 2013
Victor Aguirre Individual Corporate DirectorBoard Member Jul 5, 2011

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1720468804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1513 S GRAND AVE",
            "address_2": "SUITE 220 & 250",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153070",
            "telephone_number": "213-747-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 S GRAND AVE",
            "address_2": "SUITE 220 & 250",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153070",
            "telephone_number": "213-747-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "SR VP, COO & INTERIM-CEO",
        "authorized_official_telephone_number": "213-747-5542"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eisner Pediatric and Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.