NPIMap

Organization Active NPI

Family Health Medical Center Inc.

  • Rural Health Clinic/Center
  • Los Banos, CA
National Provider Identifier
1780120220
Registry record updated Oct 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
A61093 Issued in CA
Legal business name
FAMILY HEALTH MEDICAL CENTER INC.
Practice address
444 Santa Rita Avenue
Los Banos, CA 93635-4204
Phone
(209) 827-4747
Fax
(209) 827-5831
NPI assigned
Jan 9, 2017
Organization subpart
Yes
Parent organization
FAMILY HEALTH MEDICAL CENTER INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 5, 2018

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

Authorized official

Name
Lisa Hawthorne
Title
Office Manager
Phone
(209) 827-4747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X A61093 CA Primary

Addresses

Primary practice location

444 Santa Rita Avenue
Los Banos, CA 93635-4204

Mailing address

1045 5TH St
Los Banos, CA 93635-4204
Phone (209) 827-4747

Other identifiers 1

IdentifierTypeStateIssuer
A61093OtherCAMD LICENSE

Other names 1

  • ACCESS FAMILY MEDICAL CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170705002450 CA Part A Provider - Rural Health Clinic 6507991676 Practice locations: Los Banos, CA

Rural health clinic certification: CCN 058997

Legal name
FAMILY HEALTH MEDICAL CENTER INC.
Doing business as
ACCESS FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 25, 2018
Last certification
Jul 25, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Oct 19, 2009 in CA
Enrollment address
444 Santa Rita Ave
Los Banos, CA 93635-3838

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2132088Access Family Medical Center444 Santa Rita Ave, Los Banos, CA 93635Certificate of waiverJun 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Family Health Medical Center Inc3 organizations share this tax ID, including this one
Part of
Family Health Medical Center Inc

Other organizations with this tax ID 2

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

Locations

444 Santa Rita Ave
Los Banos, CA 93635
Phone (209) 710-0802

1045 5th St
Los Banos, CA 93635
Phone (209) 827-4747

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Mohammad Said Al Hasan Individual 5% Or Greater Direct Ownership Interest Feb 1, 2017 51%
Sunny S Park Individual 5% Or Greater Direct Ownership InterestCfo Secretary FNP Feb 1, 2017 49%
Operational/Managerial Control Feb 1, 2017 51%
Other Feb 1, 2017
Lisa M Hawthorne Individual W-2 Managing EmployeeOffice Manager Feb 1, 2017
Central Valley Family Healthcare Inc Organization, Los Banos, CA Management services company Operational/Managerial Control Feb 1, 2017 100%

Owners & managing parties with NPI records 2

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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": "1483920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538697600000",
    "number": "1780120220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 5TH ST",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936354204",
            "telephone_number": "209-827-4747",
            "fax_number": "209-827-5831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 SANTA RITA AVENUE",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936354204",
            "telephone_number": "209-827-4747",
            "fax_number": "209-827-5831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH MEDICAL CENTER INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAMILY HEALTH MEDICAL CENTER INC.",
        "enumeration_date": "2017-01-09",
        "last_updated": "2018-10-05",
        "status": "A",
        "authorized_official_last_name": "HAWTHORNE",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "209-827-4747"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "A61093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "A61093",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ACCESS FAMILY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Banos, CA

Sources for this page

Verify at the official NPI Registry.