NPIMap

Organization Active NPI

Beverlycare

  • Federally Qualified Health Center (FQHC)
  • Montebello, CA
National Provider Identifier
1760936884
Registry record updated Oct 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BEVERLYCARE
Practice address
101 E Beverly Blvd
Suite 303
Montebello, CA 90640-4300
Phone
(323) 837-5147
NPI assigned
Aug 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2024

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

Authorized official

Name
Angel Hsiao
Title
Interim Ceo
Phone
(909) 939-1319

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

101 E Beverly Blvd
Suite 303
Montebello, CA 90640-4300

Mailing address

101 E Beverly Blvd Ste 303
Montebello, CA 90640-4316
Phone (323) 726-1400

Other names 2

  • BeverlyCare Other name
  • BeverlyCare Family Clinic Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180727002401 CA Part B Supplier - Clinic/Group Practice 9537416102 Receives reassigned benefits from 3 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Montebello, CA
O20200615002307 CA Part A Provider - Federally Qualified Health Center (FQHC) 9537416102 Practice locations: Montebello, CA

Federally qualified health center certification: CCN 921944

Legal name
BEVERLYCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 22, 2020
Last certification
May 22, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 18, 2015 in CA
Enrollment address
101 E Beverly Blvd
Ste 303
Montebello, CA 90640-4316

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 2

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

National Provider Directory

National Provider Directory
Tax ID family
Beverlycare4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

2101 W Beverly Blvd
Montebello, CA 90640
Phone (213) 721-5788

8862 Whittier Blvd
Pico Rivera, CA 90660
Phone (323) 725-5006

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Corali Nakamatsu Individual Corporate OfficerExecutive Director Apr 1, 2020
W-2 Managing EmployeeExecutive Director Jun 1, 2018

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728259200000",
    "number": "1760936884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E BEVERLY BLVD STE 303",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404316",
            "telephone_number": "323-726-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E BEVERLY BLVD",
            "address_2": "SUITE 303",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404300",
            "telephone_number": "323-837-5147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLYCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2024-10-07",
        "certification_date": "2024-10-07",
        "status": "A",
        "authorized_official_last_name": "HSIAO",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_title_or_position": "INTERIM CEO",
        "authorized_official_telephone_number": "909-939-1319"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BeverlyCare",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "BeverlyCare Family Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Montebello, CA

Sources for this page

Verify at the official NPI Registry.