NPIMap

Organization Active NPI

Health Service Alliance

  • Psychologist
  • Claremont, CA
National Provider Identifier
1720675986
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
HEALTH SERVICE ALLIANCE
Practice address
220 S Indian Hill Blvd Ste F
Claremont, CA 91711-4929
Phone
(909) 281-5800
NPI assigned
Dec 22, 2020
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Mr. Jeffrey J Cox
Title
Cfo
Phone
(909) 464-9675

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

220 S Indian Hill Blvd Ste F
Claremont, CA 91711-4929

Mailing address

220 S Indian Hill Blvd Ste F
Claremont, CA 91711-4929
Phone (909) 281-5800

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040708000369 CA Part B Supplier - Clinic/Group Practice 4587642467 Receives reassigned benefits from 20 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palm Desert, CA; Upland, CA; Rancho Cucamonga, CA; Montclair, CA; Hesperia, CA; Claremont, CA
O20210302002849 CA Part A Provider - Federally Qualified Health Center (FQHC) 4587642467 Practice locations: Claremont, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720675986. Details of each certification follow.

Federally qualified health center certification: CCN 921982

Legal name
HEALTH SERVICE ALLIANCE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 11, 2021
Last certification
Jan 11, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2003 in CA
Enrollment address
220 S Indian Hill Blvd
Ste F
Claremont, CA 91711-4929

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Gregory Hafif Individual Corporate DirectorBoard Member Dec 15, 2020 12.5%
Health Service Alliance Organization, Claremont, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 15, 2020 100%
James M Lally Individual Corporate OfficerCmo Jan 1, 2020 25%
Earl Elrod Individual Corporate DirectorBoard Member Dec 15, 2020 12.5%
Christian Grelling Individual Corporate OfficerCco Jan 1, 2020 25%
Ester Pipersky Individual Corporate DirectorBoard Member Dec 15, 2020 12.5%
Danielle M Vea Individual Corporate OfficerCoo Jan 1, 2020 25%
Jeffrey J Cox Individual Corporate OfficerCfo/Cio Dec 15, 2020 40%
Juan Banos Individual Corporate DirectorBoard Member Dec 15, 2020 12.5%
Sally Hernandez Individual W-2 Managing EmployeeOffice Manager Jan 1, 2019 5%

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Chino Valley Community Health CenterChino, CA, CCN 921185 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 27, 2003
Health Service AllianceMontclair, CA, CCN 921194 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 27, 2003
The S. Newandee MD Community Health CenterRancho Cucamonga, CA, CCN 921981 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2021
Health Service AlliancePalm Desert, CA, CCN A01123 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2022
Rancho Cucamonga Community Health CenterRancho Cucamonga, CA, CCN A01179 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2023

Owned or controlled facilities with NPI records 2

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.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1608595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1720675986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 S INDIAN HILL BLVD STE F",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917114929",
            "telephone_number": "909-281-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 S INDIAN HILL BLVD STE F",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917114929",
            "telephone_number": "909-281-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH SERVICE ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-22",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "909-464-9675",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Claremont, CA

Sources for this page

Verify at the official NPI Registry.