NPIMap

Organization Active NPI

Altamed Health Services Corp

Doing business as AltaMed Medical and Dental Group-Commerce, Goodrich

  • Federally Qualified Health Center (FQHC)
  • Commerce, CA
National Provider Identifier
1770006728
Registry record updated Jul 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ALTAMED HEALTH SERVICES CORP
Doing business as
AltaMed Medical and Dental Group-Commerce, Goodrich
Practice address
972 Goodrich Boulevard
Commerce, CA 90022-4114
Phone
(323) 622-2449
NPI assigned
Jul 21, 2017
Last updated
Jul 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2017

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

Authorized official

Name
Robert U. Young, MD
Title
VP, Patient Financial Services
Phone
(323) 622-2429

Specialties & licenses 1

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

Addresses

Primary practice location

972 Goodrich Boulevard
Commerce, CA 90022-4114

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (323) 622-2429

Other names 1

  • AltaMed Medical and Dental Group-Commerce, Goodrich Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180430001307 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Commerce, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770006728. Details of each certification follow.

Federally qualified health center certification: CCN 921064

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL AND DENTAL GROUP-COMMERCE,GOODRICH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 17, 2018
Last certification
Apr 17, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
972 Goodrich Blvd
Commerce, CA 90022-4114

Other NPIs with the same Medicare PAC ID 22

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

View all 22

National Provider Directory

National Provider Directory
Tax ID family
Altamed Health Ser117 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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
Maria Grimaldo Individual Corporate DirectorBoard Member Oct 29, 2013
Jose Avalos Individual Corporate DirectorBoard Chair Jun 28, 2018
Adolfo O Chanez Individual Corporate DirectorBoard Member Feb 25, 2016
Castulo de la Rocha Individual Corporate OfficerPresident and Ceo Mar 1, 1997
Marc Victor Individual Corporate DirectorTreasurer Oct 26, 2017
Ricardo Robles Individual Corporate DirectorVice Chair Jan 22, 2015
Victor Olmos Individual Corporate DirectorBoard Member Oct 23, 2020
Joseph Gomez Individual Corporate DirectorBoard Member Sep 6, 2019
Jose Ubaldo Esparza Individual Corporate OfficerEvp, Finance & Cfo Jan 20, 1994
Robert Young Individual W-2 Managing EmployeeVP, Patient Financial Services Jan 6, 2012
Nadia Paola Alvarez Individual Corporate DirectorBoard Member Sep 6, 2019
Lucy Maria Herrera Individual Corporate DirectorBoard Secretary Nov 5, 2019

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1500595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500595200000",
    "number": "1770006728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 CAMFIELD AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900401501",
            "telephone_number": "323-622-2429",
            "fax_number": "323-889-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "972 GOODRICH BOULEVARD",
            "city": "COMMERCE",
            "state": "CA",
            "postal_code": "900224114",
            "telephone_number": "323-622-2449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-21",
        "last_updated": "2017-07-21",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "U.",
        "authorized_official_title_or_position": "VP, PATIENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "323-622-2429",
        "authorized_official_credential": "MD"
    },
    "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": "AltaMed Medical and Dental Group-Commerce, Goodrich",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AltaMed Medical and Dental Group-Commerce, Goodrich",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Commerce, CA

Sources for this page

Verify at the official NPI Registry.