Family Health Medical Center Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

G74536 Issued in CA

Legal business name

FAMILY HEALTH MEDICAL CENTER INC.

Doing business as

Family Health Medical Center, Inc.

Practice address

1045 5TH St
Los Banos, CA 93635-4204

Phone

(209) 827-4747

Fax

(209) 827-5831

NPI assigned

Oct 8, 2009

Last updated

May 15, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mohammed Al-Hasan, M.D.

Title

Owner/Physician

Phone

(209) 827-4747

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• FAMILY HEALTH MEDICAL CENTER, INC. Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841525862. Details of each certification follow.

• CCN 058951 Rural health clinic · Active · Details

Rural health clinic certification: CCN 058951

Legal name

FAMILY HEALTH MEDICAL CENTER INC.

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 2, 2010

Last certification

Aug 14, 2019

Ownership / control type

1B

Organization structure

CorporationProprietary

Incorporated

Oct 19, 2009 in CA

Enrollment address

1045 5TH St
Los Banos, CA 93635-4204

Other NPIs with the same Medicare PAC ID 1

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

• Family Health Medical Center Inc.

  dba Access Family Medical Center

  • Rural Health Clinic/Center
  • Los Banos, CA
  • NPI 1780120220

  6507991676

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Family Health Medical Center Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Family Health Medical Center Inc.

  dba Access Family Medical Center

  • Rural Health Clinic/Center
  • Los Banos, CA
  • NPI 1780120220
  NPD tax ID
• Family Healthcare of Chowchilla

  • Rural Health Clinic/Center
  • Chowchilla, CA
  • NPI 1013314046
  NPD tax ID

Locations

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 2

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

• Mohammad Said Al Hasan, MD

  • Nephrology Physician
  • Hollister, CA
  • NPI 1932183829

  5% Or Greater Direct Ownership Interest, Corporate Director

  CMS ownership
• Sunny Sunjoo Park, FNP

  • Family Nurse Practitioner
  • Turlock, CA
  • NPI 1134445745

  5% Or Greater Direct Ownership Interest, Contracted Managing Employee, Corporate Officer

  CMS ownership

Subparts reporting this organization as parent 2

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

• Family Health Medical Center Inc.

  dba Access Family Medical Center

  • Rural Health Clinic/Center
  • Los Banos, CA
  • NPI 1780120220
  NPPES parent name
• Family Healthcare of Chowchilla

  • Rural Health Clinic/Center
  • Chowchilla, CA
  • NPI 1013314046
  NPPES parent name

Practitioners 4

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.

• Mohammad Said Al Hasan, MD

  • Nephrology Physician
  • Hollister, CA
  • NPI 1932183829
  NPD (past)
• Daniel Koh, CHW

  • Community Health Worker
  • Los Banos, CA
  • NPI 1386575108
  NPD (past)
• Sunny Sunjoo Park, FNP

  • Family Nurse Practitioner
  • Turlock, CA
  • NPI 1134445745
  NPD (past)
• Apinya Smothers, PA-C

  • Physician Assistant
  • Los Banos, CA
  • NPI 1336699065
  NPD (past)

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1841525862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 5TH ST",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936354204",
            "telephone_number": "209-827-4747",
            "fax_number": "209-827-5831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 5TH ST",
            "city": "LOS BANOS",
            "state": "CA",
            "postal_code": "936354204",
            "telephone_number": "209-827-4747",
            "fax_number": "209-827-5831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH MEDICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "AL-HASAN",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "209-827-4747",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "CA",
            "license": "G74536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841525862",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY HEALTH MEDICAL CENTER, INC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel L Eustace, P.A.-C.
• Glenn Ernest Fabian
• Faithful Foundations ABA LLC
• Stephanie Fajardo
• Family Health Medical Center Inc. (Access Family Medical Center)
• Faizan Farid, DDS
• Komel Feleyeh
• Michael Francis Fisher, PA
• Maritza Flores-Avalos
• Adriana Flores

• Rural Health Clinic/Center in Los Banos, CA
• Providers in Los Banos, CA by specialty
• Rural Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.