NPIMap

Organization Active NPI

Altamed Health Services Corp

Doing business as AltaMed Medical Group-Huntington Park

  • Federally Qualified Health Center (FQHC)
  • Huntington Park, CA
National Provider Identifier
1790177582
Registry record updated Jul 21, 2022
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 Group-Huntington Park
Practice address
1900 E Slauson Ave
Huntington Park, CA 90255-2725
Phone
(323) 487-4110
Fax
(323) 923-5370
NPI assigned
Mar 3, 2015
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

1900 E Slauson Ave
Huntington Park, CA 90255-2725

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (323) 725-8751

Other names 1

  • AltaMed Medical Group-Huntington Park Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA10 enrollments

Enrollment records 10

Enrollment IDStateProvider typePAC IDDetails
O20151228002367 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Huntington Park, CA
O20210607002844 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 1 other NPI on this enrollment
Practice locations: El Monte, CA
O20210608002342 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 1 other NPI on this enrollment
Practice locations: Pasadena, CA
O20210712002597 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Los Angeles, CA
O20210810003719 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Huntington Park, CA
O20240426003396 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Pasadena, CA
O20240430004290 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: El Monte, CA
O20240612004302 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: South El Monte, CA
O20240628000853 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Monrovia, CA
O20241011003954 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Pasadena, CA

NPI to CCN mapping 10

The Medicare certification numbers (CCNs) connected to NPI 1790177582. Details of each certification follow.

Federally qualified health center certification: CCN 751829

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-HUNTINGTON PARK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 25, 2015
Last certification
Nov 25, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
1900 E Slauson Ave
Huntington Park, CA 90255-2725

Federally qualified health center certification: CCN 921967

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-EL MONTE,SANTA ANITA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 2021
Last certification
Jun 7, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
3208 Santa Anita Ave
Suite 200
El Monte, CA 91733-1304

Federally qualified health center certification: CCN 921968

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-PASADENA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 8, 2021
Last certification
Jun 8, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
2661 E Washington Blvd
Pasadena, CA 91107-1412

Federally qualified health center certification: CCN 921976

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-FLORENCE-FIRESTONE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 12, 2021
Last certification
Jul 12, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
1542 E Florence Ave
Los Angeles, CA 90001-2536

Federally qualified health center certification: CCN 921989

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-HUNTINGTON PARK, RUGBY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 4, 2021
Last certification
Aug 4, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
6601 Rugby Ave
Ste 300
Huntington Park, CA 90255-4046

Federally qualified health center certification: CCN A01873

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-PASADENA, LAKE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 10, 2024
Last certification
Apr 10, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
1595 N Lake Ave
Pasadena, CA 91104-2307

Federally qualified health center certification: CCN A01857

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-EL MONTE, GARVEY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 15, 2024
Last certification
Apr 15, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
10127 Garvey Ave
El Monte, CA 91733-2066

Federally qualified health center certification: CCN A01863

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-EL MONTE, VACCO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 10, 2024
Last certification
May 10, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
10408 Vacco St
South El Monte, CA 91733-3328

Federally qualified health center certification: CCN A01865

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP - MONROVIA, LIME
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 14, 2024
Last certification
Jun 14, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
513 E Lime Ave
Ste 102
Monrovia, CA 91016-2983

Federally qualified health center certification: CCN A01887

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-PASADENA, DEL MAR
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 5, 2024
Last certification
Sep 5, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
3160 E del Mar Blvd
Ste 100
Pasadena, CA 91107-4649

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

Other NPIs on the same Medicare enrollment 1

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

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
05D2102128Altamed Medical Group1900 E. Slauson Avenue Ste 205, Huntington Park, CA 90255Certificate of waiverSep 15, 2027
05D2228574Altamed Medical Group - Florence - Firestone1542 E Florence Ave, Los Angeles, CA 90001Certificate of waiverJun 28, 2027
05D2231509Altamed Medical Group - Huntington Park, Rugby6601 Rugby Ave, Huntington Park, CA 90255Certificate of waiverAug 2, 2027
05D2231511Altamed Medical Group - El Monte, Santa Anita3208 Santa Anita Ave, El Monte, CA 91733Certificate of waiverAug 2, 2027
05D2296365Altamed Medical Group - El Monte Vacco10408 Vacco St Ste a, South El Monte, CA 91733Certificate of waiverDec 26, 2027
05D2296367Altamed Medical Group Pasadena Lake1595 N Lake Ave, Pasadena, CA 91104Certificate of waiverDec 26, 2027
05D2296370Altamed Medical Group Monrovia Lime513 E Lime Ave Ste 102, Monrovia, CA 91016Certificate of waiverDec 26, 2027
05D2296372Altamed Medical Group Pasadena del Mar3160 E del Mar Blvd Ste 100, Pasadena, CA 91107Certificate of waiverDec 26, 2027
05D2297611Altamed Medical Group El Monte Garvey10127 Garvey Ave, El Monte, CA 91733Certificate of waiverJan 17, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 17

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 DirectorConsumer Board Member Oct 29, 2013
Jose Avalos Individual Corporate DirectorBoard Chair Jun 28, 2018
Corporate DirectorBoard Vice Chairman Jun 28, 2018
Corporate DirectorChair, Board Member Jun 28, 2018
Adolfo O Chanez Individual Corporate DirectorBoard Member Feb 25, 2016
Castulo de la Rocha Individual Corporate OfficerPresident and Ceo Mar 1, 1977
Corporate OfficerPresident & Ceo Mar 1, 1977
Corporate OfficerPresident and Ceo Mar 1, 1997
Marc Victor Individual Corporate DirectorTreasurer Oct 26, 2017
Corporate DirectorInterim Board Treasurer Oct 26, 2017
Corporate DirectorBoard Member Oct 26, 2017
Ricardo Robles Individual Corporate DirectorVice Chair Jan 22, 2015
Corporate DirectorBoard Secretary Jan 22, 2015
Corporate DirectorSecretary, Consumer Board Member Jan 22, 2015
Victor Olmos Individual Corporate DirectorBoard Member Oct 23, 2020
Corporate DirectorTreasurer, Board Member Oct 23, 2020
Joseph Gomez Individual Corporate DirectorBoard Member Sep 6, 2019
Corporate DirectorConsumer Board Member Sep 6, 2019
Jose Ubaldo Esparza Individual Corporate OfficerEvp, Finance and Cfo Jan 20, 1994
Corporate OfficerSr VP of Finance & Cfo Jan 20, 1994
Corporate OfficerEvp, Finance and Cfo Jan 6, 2012
Corporate OfficerEvp, Finance and Cfo Mar 1, 1997
Corporate OfficerEvp Finance and Cfo Jan 6, 2012
Robert Young Individual W-2 Managing EmployeeVP Patient Financial Services Jan 5, 2009
W-2 Managing EmployeeVice President, PFS Jan 6, 2012
Nadia Paola Alvarez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Lucy Maria Herrera Individual Corporate DirectorSecretary Oct 25, 2019
Corporate DirectorConsumer Board Member Oct 25, 2019
Corporate DirectorVice Chair, Consumer Board Member Nov 5, 2019
Sarkis Karakesisoglu Individual Corporate DirectorConsumer Board Member Oct 23, 2020
Hector Barreto Individual Corporate DirectorBoard Chairman Sep 6, 2019
Maria Cervantes Individual Corporate DirectorBoard Member Jun 28, 2018
Robert Rodriguez Individual Corporate DirectorConsumer Board Member Jan 1, 2024
Jay P Lee Individual Corporate DirectorBoard Member Jan 1, 2024

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": "1425340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1790177582",
    "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": "323-725-8751",
            "fax_number": "323-889-7399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 E SLAUSON AVE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552725",
            "telephone_number": "323-487-4110",
            "fax_number": "323-923-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-03",
        "last_updated": "2022-07-21",
        "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": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AltaMed Medical Group-Huntington Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington Park, CA

Sources for this page

Verify at the official NPI Registry.