NPIMap

Organization Active NPI

Operation Samahan, Inc.

  • Federally Qualified Health Center (FQHC)
  • National City, CA
National Provider Identifier
1801907449
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
090000183 Issued in CA
Legal business name
OPERATION SAMAHAN, INC.
Practice address
2743 Highland Ave.
National City, CA 91950-4624
Phone
(844) 200-2426
Fax
(619) 356-2726
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Authorized official

Name
Archie Bella, MDNPI 1487098497
Title
Ceo/Cmo
Phone
(844) 200-2426

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 090000183 CA Primary

Addresses

Primary practice location

2743 Highland Ave.
National City, CA 91950-4624

Mailing address

1428 Highland Avenue
National City, CA 91950-4624
Phone (844) 200-2426

Other identifiers 7

IdentifierTypeStateIssuer
FHC70250FOtherCAMEDICAID
W9341OtherCAMEDICARE
BCP70250FOtherCAMEDICAID
EAP70250FOtherCAMEDICAID
CMM70250FOtherCAMEDICAID
HAP70250FOtherCAMEDICAID
63OtherCASAN DIEGO CMS

Other names 1

  • Operation Samahan Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051001000054 CA Part B Supplier - Clinic/Group Practice 7911932645 Receives reassigned benefits from 42 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Diego, CA; National City, CA
O20060929000502 CA Part A Provider - Federally Qualified Health Center (FQHC) 7911932645 Practice locations: National City, CA

Federally qualified health center certification: CCN 051060

Legal name
OPERATION SAMAHAN INC
Doing business as
OPERATION SAMAHAN CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 3, 2006
Last certification
Nov 3, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 31, 2006 in CA
Enrollment address
2743 Highland Ave
National City, CA 91950-7410

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Locations

2835 Highland Ave
Ste A
National City, CA 91950
Phone (618) 474-5567

2835 Highland Ave
Ste C
National City, CA 91950

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Purita Andrews Individual Corporate Officer Sep 1, 2015
Aleth Madriaga Individual Corporate Officer Nov 16, 2016
Elidoro Primero Individual Corporate OfficerCfo Aug 1, 2019
W-2 Managing EmployeeCfo Aug 1, 2019
Guillermo Lara Individual Corporate OfficerHR Director Sep 1, 2019
W-2 Managing EmployeeHR Director Sep 1, 2019
Brandon Meza Individual Corporate Officer Feb 17, 2017
Oscar Campos Individual Corporate Officer Feb 17, 2017
Operation Samahan Inc Organization, National City, CA Corporation, Medical provider/supplier, Non-profit Operational/Managerial Control Sep 20, 2006 100%
Shearl Lambert Individual Corporate DirectorVice Chair Aug 1, 2019

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Operation Samahan OutreachSan Diego, CA, CCN 051061 Federally qualified health center Operational/Managerial Control (100%) Nov 3, 2006
Samahan Health CentersNational City, CA, CCN 751022 Federally qualified health center Other (100%) May 15, 1973
Operation Samahan IncSan Diego, CA, CCN A11035 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2025

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1801907449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1428 HIGHLAND AVENUE",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919504624",
            "telephone_number": "844-200-2426",
            "fax_number": "619-356-2726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2743 HIGHLAND AVE.",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919504624",
            "telephone_number": "844-200-2426",
            "fax_number": "619-356-2726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPERATION SAMAHAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "BELLA",
        "authorized_official_first_name": "ARCHIE",
        "authorized_official_title_or_position": "CEO/CMO",
        "authorized_official_telephone_number": "844-200-2426",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "090000183",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "FHC70250F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "W9341",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "BCP70250F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "EAP70250F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "CMM70250F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "HAP70250F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SAN DIEGO CMS",
            "identifier": "63",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Operation Samahan Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Operation Samahan Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in National City, CA

Sources for this page

Verify at the official NPI Registry.