NPIMap

Organization Active NPI

Prime Healthcare Huntington Beach LLC

Doing business as Huntington Beach Hospital

  • Psychiatric Hospital Unit
  • Huntington Beach, CA
National Provider Identifier
1780986356
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
060000124 Issued in CA
Legal business name
PRIME HEALTHCARE HUNTINGTON BEACH LLC
Doing business as
Huntington Beach Hospital
Practice address
17772 Beach Blvd
Huntington Beach, CA 92647-6819
Phone
(714) 843-5000
NPI assigned
Dec 2, 2010
Last updated
Jun 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Authorized official

Name
Christopher Doan
Title
Managing Associate General Counsel
Phone
(310) 259-4706

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 060000124 CA Primary

Addresses

Primary practice location

17772 Beach Blvd
Huntington Beach, CA 92647-6819

Mailing address

17772 Beach Blvd
Huntington Beach, CA 92647-6819
Phone (714) 843-5000

Other names 1

  • Huntington Beach Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070626000560 CA Part A Provider - Hospital 4284630625 1 other NPI on this enrollment
Practice locations: Huntington Beach, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780986356. Details of each certification follow.

Hospital certification: CCN 05S526

Legal name
PRIME HEALTHCARE HUNTINGTON BEACH LLC
Doing business as
HUNTINGTON BEACH HOSPITAL
Organization structure
LLCNon-profit
Incorporated
Jul 21, 2006 in DE
Enrollment address
17772 Beach Blvd
Huntington Beach, CA 92647-6819
Other Hospital Practice Location
Hospital subgroups
Psychiatric

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

Other NPIs with the same Medicare PAC ID 1

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
Prime Healthcare Huntington Beach LLC2 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.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 6

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, Ontario, CA Other Jan 1, 2013
Dan Brothman Individual Corporate OfficerChief Executive Officer Jan 1, 2023
Corporate DirectorChairperson Jan 1, 2023
W-2 Managing EmployeeChief Executive Officer Jan 1, 2023
Prime Healthcare Huntington Beach LLC Organization, Ontario, CA Created for acquisition, Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 2006 100%
Steven Aleman Individual OtherChief Financial Officer Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Apr 24, 2017
Prime Healthcare Foundation Inc Organization, Ontario, CA Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2013 100%

Owners & managing parties with NPI records 2

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

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1780986356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17772 BEACH BLVD",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476819",
            "telephone_number": "714-843-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17772 BEACH BLVD",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926476819",
            "telephone_number": "714-843-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE HUNTINGTON BEACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-02",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "MANAGING ASSOCIATE GENERAL COUNSEL",
        "authorized_official_telephone_number": "310-259-4706"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "CA",
            "license": "060000124",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Huntington Beach Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Huntington Beach Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington Beach, CA

Sources for this page

Verify at the official NPI Registry.