NPIMap

Organization Active NPI

Complete Care Community Health Center, Inc

  • PACE Provider Organization
  • South Gate, CA
National Provider Identifier
1811397888
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PACE Provider OrganizationTaxonomy code 251T00000X
Legal business name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC
Practice address
5831 Firestone Blvd Ste E
South Gate, CA 90280-3718
Phone
(562) 806-7545
Fax
(562) 806-6062
NPI assigned
Aug 27, 2014
Last updated
Apr 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

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

Authorized official

Name
Mr. Yury Akopyan
Title
Ceo
Phone
(562) 806-7545

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PACE Provider Organization 251T00000X NU Primary

Addresses

Primary practice location

5831 Firestone Blvd Ste E
South Gate, CA 90280-3718

Mailing address

5831 Firestone Blvd Ste E
South Gate, CA 90280-3718
Phone (562) 806-7545

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080521000478 CA Part B Supplier - Clinic/Group Practice 3779494190 Receives reassigned benefits from 99 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; South Gate, CA
O20151208002645 CA Part A Provider - Federally Qualified Health Center (FQHC) 3779494190 Practice locations: South Gate, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811397888. Details of each certification follow.

Federally qualified health center certification: CCN 751828

Legal name
COMPLETE CARE COMMUNITY HEALTH CENTER, INC
Doing business as
COMPLETE CARE HEALTH CENTER - SOUTH GATE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 19, 2015
Last certification
Oct 19, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 14, 2003 in CA
Enrollment address
5831 Firestone Blvd
Ste E
South Gate, CA 90280-3718

Other NPIs with the same Medicare PAC ID 11

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.

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
05D1066823Complete Care Health Center-South Gate5831 Firestone Blvd Ste E, South Gate, CA 90280Certificate of waiverApr 2, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Inessa Miretsky Individual Corporate DirectorBoard Member Sep 27, 2020
Yury Akopyan Individual Corporate OfficerCeo Nov 2, 2012
W-2 Managing EmployeeCeo Nov 2, 2012
Operational/Managerial ControlCeo Nov 2, 2012
Dina E Belensky Individual Corporate Officer Oct 9, 2015
Corporate DirectorBoard Chair Sep 12, 2006
Joyce Reese Individual Corporate DirectorBoard Member Sep 27, 2020
Mariella Menbreno Individual Corporate DirectorBoard Member Sep 27, 2020
Viktoriya Makerova Individual Corporate Officer Oct 9, 2015
Corporate DirectorBoard Member Jun 13, 2012
Sonia Henriquez Individual Corporate DirectorBoard Member Sep 27, 2020
Anthony L Willis Individual Corporate Officer Oct 9, 2015
Corporate DirectorBoard Member May 9, 2012
Marisol Jimenez Individual Corporate Director Sep 27, 2020
Ernesto Haro Individual Corporate Director Sep 27, 2020
Wendy Navarrete Individual Corporate DirectorBoard Member Sep 27, 2020

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Complete Care Community Health Center - AltadenaPasadena, CA, CCN 751945 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2016
Complete Care Community Health Center - Monterey ParkMonterey Park, CA, CCN 921927 Federally qualified health center Operational/Managerial Control Oct 14, 2003
Complete Care Community Health Center - Monterey ParkMonterey Park, CA, CCN 921928 Federally qualified health center Operational/Managerial Control Oct 14, 2003
Complete Care Community Health Center - Huntington ParkHuntington Park, CA, CCN 921925 Federally qualified health center Operational/Managerial Control Oct 14, 2003

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1409097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1811397888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5831 FIRESTONE BLVD STE E",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902803718",
            "telephone_number": "562-806-7545",
            "fax_number": "562-806-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5831 FIRESTONE BLVD STE E",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902803718",
            "telephone_number": "562-806-7545",
            "fax_number": "562-806-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE CARE COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-27",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "AKOPYAN",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-806-7545",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Gate, CA

Sources for this page

Verify at the official NPI Registry.