NPIMap

Organization Active NPI

University of California Irvine

Doing business as UCI Family Health Center - Santa Ana Mobile Unit

  • Federally Qualified Health Center (FQHC)
  • Santa Ana, CA
National Provider Identifier
1730349960
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
060000148 Issued in CA
Legal business name
UNIVERSITY OF CALIFORNIA IRVINE
Doing business as
UCI Family Health Center - Santa Ana Mobile Unit
Practice address
800 N Main St
Santa Ana, CA 92701-3576
Phone
(714) 456-3006
Fax
(714) 456-3961
NPI assigned
Jun 11, 2008
Last updated
Nov 4, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
UCI MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

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

Authorized official

Name
Gina Churchill
Title
Reimbursement Director
Phone
(714) 509-6266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 060000148 CA Primary

Addresses

Primary practice location

800 N Main St
Santa Ana, CA 92701-3576

Mailing address

1500 S Douglass Blvd, #200 RT 183
Anaheim, CA 92806
Phone (714) 509-6266

Other names 1

  • UCI Family Health Center - Santa Ana Mobile Unit Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111111000705 CA Part A Provider - Federally Qualified Health Center (FQHC) 5395658181 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Ana, CA
O20111220000103 CA Part A Provider - Federally Qualified Health Center (FQHC) 5395658181 Practice locations: Santa Ana, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1730349960. Details of each certification follow.

Federally qualified health center certification: CCN 051893

Legal name
UNIVERSITY OF CALIFORNIA IRVINE
Doing business as
UCI FAMILY HEALTH CENTER SANTA ANA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 1, 1993
Last certification
May 1, 1993
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jun 18, 1868 in CA
Enrollment address
800N Main St
Santa Ana, CA 92701-3576

Federally qualified health center certification: CCN 551965

Legal name
UNIVERSITY OF CALIFORNIA IRVINE
Doing business as
UCI FAMILY HEALTH CENTER-SANTA ANA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 16, 2004
Last certification
Apr 16, 2004
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jun 18, 1868 in CA
Enrollment address
800 N Main St
Santa Ana, CA 92701-3576
Related CCNs
050348

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Uci Student Health Center Pharmacy42 organizations share this tax ID, including this one
Part of
Uci Student Health Center Pharmacy

Other organizations with this tax ID 41

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

View all 41

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Randolph Peseverance Siwabessy Individual Corporate DirectorChief Financial Officer May 10, 2021 100%
W-2 Managing EmployeeChief Financial Officer May 10, 2021 100%
Operational/Managerial ControlChief Financial Officer May 10, 2021 100%
Rennie Horneman Individual Corporate DirectorBoard of Directors Sep 26, 2022 1%
Michael a Jaimes Individual Corporate DirectorChairperson - FQHC Board Jan 1, 2008 1%
Gina L Churchill Individual W-2 Managing EmployeeReimbursement Director Jul 1, 2015 5%
Corporate DirectorReimbursement Director Jul 1, 2015 5%
Pablo Velasquez Individual Corporate DirectorBoard of Directors Nov 21, 2022 1%
Lauren Irving Individual Corporate DirectorSecretary Jul 1, 2018 1%
University of California Irvine Organization, Orange, CA Non-profit 5% Or Greater Direct Ownership Interest May 1, 1993 100%
5% Or Greater Direct Ownership Interest Mar 20, 2004 100%
Operational/Managerial Control Mar 20, 2004 100%
Luisa Ruiz Individual Corporate DirectorBoard Member - FQHC Board May 1, 2016 1%
Chad Thurman Lefteris Individual Corporate DirectorChief Operating Officer Jul 1, 2019 100%
Operational/Managerial ControlChief Operating Officer Jul 1, 2016 100%
Corporate OfficerChief Executive Officer Jul 1, 2020 100%
W-2 Managing EmployeeChief Executive Officer Jul 1, 2020 100%
Operational/Managerial ControlChief Executive Officer Jul 1, 2020 100%
Jeffrey Page Individual Corporate DirectorBoard Member - FQHC Board May 1, 2016 1%
Anna Ramirez Individual Corporate Director Jul 1, 2018 1%
Howard Aaron Gillman Individual Corporate OfficerChancellor Jul 1, 2016 100%
Operational/Managerial ControlChancellor Jul 1, 2016 100%
Corporate OfficerChancellor Jul 1, 2020 100%
Stephanie Resendiz Individual Corporate Director Nov 5, 2018 1%
John J Terrones Individual Corporate DirectorMember at Large Jan 22, 2018 1%

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Uci HealthOrange, CA, CCN 050348 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 1974
Aug 1, 1974
University of California Irvine Medical CenterOrange, CA, CCN 05S348 Hospital 5% Or Greater Direct Ownership Interest Nov 19, 2007
University of California Irvine Medical CenterOrange, CA, CCN 05T348 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Uci Health - Los AlamitosLos Alamitos, CA, CCN 050551 Hospital Operational/Managerial Control (100%) Mar 26, 2024
Uci Health - LakewoodLakewood, CA, CCN 050581 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 26, 2024
Mar 26, 2024
Uci Family Health Center Santa AnaSanta Ana, CA, CCN 051893 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 1, 1993

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 6

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572825600000",
    "number": "1730349960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S DOUGLASS BLVD, #200 RT 183",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "92806",
            "telephone_number": "714-509-6266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N MAIN ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927013576",
            "telephone_number": "714-456-3006",
            "fax_number": "714-456-3961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF CALIFORNIA IRVINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UCI MEDICAL CENTER",
        "enumeration_date": "2008-06-11",
        "last_updated": "2019-11-04",
        "status": "A",
        "authorized_official_last_name": "CHURCHILL",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "REIMBURSEMENT DIRECTOR",
        "authorized_official_telephone_number": "714-509-6266"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "060000148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCI Family Health Center - Santa Ana Mobile Unit",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCI Family Health Center - Santa Ana Mobile Unit",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.