NPIMap

Organization Active NPI

Prime Healthcare Services - San Dimas LLC

Doing business as San Dimas Community Hospital

  • General Acute Care Hospital
  • San Dimas, CA
National Provider Identifier
1740447945
Registry record updated Jun 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PRIME HEALTHCARE SERVICES - SAN DIMAS LLC
Doing business as
San Dimas Community Hospital
Practice address
1350 W Covina Blvd
San Dimas, CA 91773-3245
Phone
(909) 599-6811
NPI assigned
May 16, 2008
Last updated
Jun 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2017

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

Authorized official

Name
Miss Christopher Doan
Title
Chief Compliance Counsel
Phone
(909) 235-4307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

1350 W Covina Blvd
San Dimas, CA 91773-3245

Mailing address

3300 East Guasti Road, 3Rd Floor
Chino, CA 91710-8655
Phone (909) 235-4327

Other names 1

  • San Dimas Community Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20080625000194 CA Part A Provider - Hospital 2668543281 Practice locations: San Dimas, CA
O20161101002657 CA Part B Supplier - Clinic/Group Practice 4082992623 Receives reassigned benefits from 49 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Upland, CA; Victorville, CA; San Dimas, CA; San Bernardino, CA; Pomona, CA; Banning, CA; Loma Linda, CA; Riverside, CA…
O20200827002558 CA Part A Provider - Hospital 2668543281 Practice locations: San Dimas, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1740447945. Details of each certification follow.

Hospital certification: CCN 050588

Legal name
PRIME HEALTHCARE SERVICES - SAN DIMAS LLC
Doing business as
SAN DIMAS COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 30, 1972
Last certification
Jan 24, 2024
Beds
101
Ownership / control type
Private (for profit)
Most recent change of ownership
Jul 1, 2008 (3 total)
Organization structure
LLCProprietary
Incorporated
Feb 29, 2008 in DE
Enrollment address
1350 W Covina Blvd
San Dimas, CA 91773-3245
Other Hospital Practice Location
Hospital subgroups
Acute care

Hospital certification: CCN 05U588

Legal name
PRIME HEALTHCARE SERVICES - SAN DIMAS LLC
Organization structure
LLCProprietary
Enrollment address
1350 W Covina Blvd
San Dimas, CA 91773-3245
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
San Dimas Community HospitalCCN 050588 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Premier Orthopaedic Trauma2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Onterio, CA Corporation 5% Or Greater Direct Ownership Interest Jul 1, 2008 100%
Other Nov 1, 2007
Luis Leon Individual Corporate OfficerCorporate Chief Executive Officer Jun 1, 2020
Don Slawson Individual Corporate DirectorDirector Jan 1, 2013
Steven Aleman Individual Corporate OfficerChief Financial Officer Jun 1, 2020
Emmett Badar Individual Corporate DirectorDirector Jan 1, 2013
Christopher Doan Individual Corporate OfficerManaging Associate General Counsel Jul 1, 2017
W-2 Managing Employee Aug 27, 2020
Jeffrey Templeman Individual Corporate DirectorDirector Jan 1, 2013
Robert K Metcalfe Individual Corporate DirectorDirector Jan 1, 2013
Jack Hunt Individual Corporate DirectorDirector Jan 1, 2013
Rajnish Jandial Individual Corporate DirectorDirector Jan 1, 2013
Prime Healthcare Holdings Inc Organization, Onterio, CA Holding company 5% Or Greater Indirect Ownership Interest Apr 21, 2010 100%
Parrish Scarboro Individual Corporate OfficerChief Executive Officer Jan 1, 2019
Corporate DirectorDirector Jan 1, 2019
W-2 Managing EmployeeChief Executive Officer Jan 1, 2019

Owners & managing parties with NPI records 1

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

Facilities with the same owner 77

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

View all 77

Practitioners & affiliated clinicians

Practitioners 6

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.

Affiliated clinicians 104

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 104

NPI Registry JSON

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498608000000",
    "number": "1740447945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 EAST GUASTI ROAD, 3RD FLOOR",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917108655",
            "telephone_number": "909-235-4327",
            "fax_number": "909-235-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 W COVINA BLVD",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733245",
            "telephone_number": "909-599-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - SAN DIMAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-16",
        "last_updated": "2017-06-28",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE COUNSEL",
        "authorized_official_telephone_number": "909-235-4307",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Dimas Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Dimas, CA

Sources for this page

Verify at the official NPI Registry.