NPIMap

Organization Active NPI

Bartz-Altadonna Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Lancaster, CA
National Provider Identifier
1811279763
Registry record updated May 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Practice address
43322 Gingham Ave
Lancaster, CA 93535-4576
Phone
(661) 874-4050
Fax
(661) 942-3500
NPI assigned
Sep 16, 2011
Last updated
May 21, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2025

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

Authorized official

Name
Mary Cummings
Title
Ceo
Phone
(661) 466-3895

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Case Manager/Care Coordinator 171M00000X NU
Supports Brokerage Agency 251X00000X NU

Addresses

Primary practice location

43322 Gingham Ave
Lancaster, CA 93535-4576

Mailing address

43322 Gingham Ave
Lancaster, CA 93535-4576
Phone (661) 874-4050

Other practice location 1

2520 E Palmdale Blvd
Palmdale, CA 93550-4914
Phone (661) 874-4050

Other practice location 2

43210 Gingham Ave
Lancaster, CA 93535-4512
Phone (661) 874-4050

Other practice location 3

12560 Boron Ave
Boron, CA 93516-1647
Phone (661) 874-4050

Other practice location 4

38660 Medical Center Dr Unit A200
Palmdale, CA 93551-4385
Phone (661) 874-4050

Other identifiers 1

IdentifierTypeStateIssuer
2015040MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20120702000123 CA Part B Supplier - Clinic/Group Practice 6204090178 Receives reassigned benefits from 65 practitioners
Practice locations: Boron, CA; California City, CA; Lancaster, CA
O20120808000683 CA Part A Provider - Federally Qualified Health Center (FQHC) 6204090178 Practice locations: Lancaster, CA
O20200924002497 CA Part A Provider - Federally Qualified Health Center (FQHC) 6204090178 Practice locations: Palmdale, CA
O20210714001048 CA Part A Provider - Federally Qualified Health Center (FQHC) 6204090178 Practice locations: Lancaster, CA

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1811279763. Details of each certification follow.

Federally qualified health center certification: CCN 551182

Legal name
BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 8, 2012
Last certification
Aug 8, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 20, 2010 in CA
Enrollment address
43322 Gingham Ave
Suite 105
Lancaster, CA 93535-4569

Federally qualified health center certification: CCN 921934

Legal name
BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 29, 2020
Last certification
Sep 29, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 20, 2010 in CA
Enrollment address
2520 E Palmdale Blvd
Ste a
Palmdale, CA 93550-4914

Federally qualified health center certification: CCN 921977

Legal name
BARTZ-ALTADONNA COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 14, 2021
Last certification
Jul 14, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 20, 2010 in CA
Enrollment address
43210 Gingham Ave
Lancaster, CA 93535-4512

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

9300 N Loop Blvd
Ste C
California City, CA 93505

43322 Gingham Ave
Lancaster, CA 93535
Phone (661) 579-9317

43322 Gingham Ave
Ste 104
Lancaster, CA 93535
Phone (661) 874-4051

43322 Gingham Ave
Ste 104105
Lancaster, CA 93535

2520 E Palmdale Blvd
Palmdale, CA 93550
Phone (661) 266-8551

38660 Medical Center Dr
Unit A200
Palmdale, CA 93551

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Dan M Angel Individual Corporate DirectorBoard Member Nov 1, 2025
Corporate DirectorBoard Secretary Jan 1, 2018
Corporate DirectorSecretary Board of Directors Jan 1, 2018
Tamara Bins Individual Corporate DirectorTreasurer Nov 1, 2025
Riccardo M Manson Individual Corporate DirectorBoard Member Nov 1, 2025
Corporate DirectorBoard Vice President Jan 1, 2019
Corporate DirectorVice President Board of Directors Jan 1, 2018
Matthew Anderson-Spaulding Individual Corporate DirectorSecretary Nov 1, 2025
Albertina Thornton Individual Corporate DirectorPresident Nov 1, 2025
Laura Ullah Individual Corporate DirectorBoard Member Nov 1, 2025
Ismene Hernandez Individual Corporate DirectorVP Nov 1, 2025
Allen Mizrahi Individual Corporate DirectorBoard Member Nov 1, 2025
Susan Gutierrez Individual Corporate DirectorBoard Member Nov 1, 2025
Bartz-Altadonna Community Health Center Organization, Lancaster, CA Non-profit Operational/Managerial Control May 10, 2010
5% Or Greater Direct Ownership Interest Jan 6, 2012 100%
Operational/Managerial Control Feb 1, 2021 100%
Jillian Stefano Individual Corporate DirectorBoard Member Nov 1, 2025
Mary Cummings Individual Corporate Officer Jul 30, 2018
Operational/Managerial ControlChief Executive Officer Jun 30, 2014
Corporate OfficerChief Executive Officer Jun 30, 2014 100%
W-2 Managing EmployeeChief Executive Officers Jun 30, 2014 100%
Corporate DirectorChief Executive Officer Jun 30, 2014 100%
W-2 Managing EmployeeChief Executive Officer Jun 30, 2014 100%
Peggy Labon Individual Corporate DirectorBoard Member Nov 1, 2025
Claude White Individual Corporate DirectorBoard Member Nov 1, 2025
Erlina Magalona Individual Corporate OfficerCfo Apr 29, 2024
Shelley Keller-Gage Individual Corporate DirectorBoard Member Nov 1, 2025
Ginna Nepomuceno Individual Corporate DirectorBoard Member Jan 1, 2018
Jo Ellen Vasquez Individual Corporate OfficerChief Financial Officer Jan 1, 2020
Corporate OfficerChief Financial Officer Jan 1, 2019
Livia Coming Individual Corporate DirectorBoard President Jan 1, 2018
Maria Estrada Individual Corporate DirectorBoard Treasurer Jan 1, 2019

Owners & managing parties with NPI records 1

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 78

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 78

NPI Registry JSON

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

{
    "created_epoch": "1316131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747785600000",
    "number": "1811279763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43322 GINGHAM AVE",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935354576",
            "telephone_number": "661-874-4050",
            "fax_number": "661-942-3500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43322 GINGHAM AVE",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935354576",
            "telephone_number": "661-874-4050",
            "fax_number": "661-942-3500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2520 E Palmdale Blvd",
            "address_purpose": "LOCATION",
            "city": "Palmdale",
            "state": "CA",
            "postal_code": "935504914",
            "country_code": "US",
            "telephone_number": "661-874-4050",
            "fax_number": "661-874-4051",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "43210 Gingham Ave",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "CA",
            "postal_code": "935354512",
            "country_code": "US",
            "telephone_number": "661-874-4050",
            "fax_number": "888-977-1571",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12560 Boron Ave",
            "address_purpose": "LOCATION",
            "city": "Boron",
            "state": "CA",
            "postal_code": "935161647",
            "country_code": "US",
            "telephone_number": "661-874-4050",
            "fax_number": "866-572-7851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "38660 Medical Center Dr Unit A200",
            "address_purpose": "LOCATION",
            "city": "Palmdale",
            "state": "CA",
            "postal_code": "935514385",
            "country_code": "US",
            "telephone_number": "661-874-4050",
            "fax_number": "866-572-7851",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BARTZ-ALTADONNA COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-16",
        "last_updated": "2025-05-21",
        "certification_date": "2025-05-21",
        "status": "A",
        "authorized_official_last_name": "CUMMINGS",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "661-466-3895"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, CA

Sources for this page

Verify at the official NPI Registry.