NPIMap

Organization Active NPI

University of California Irvine

Doing business as UCI Family Health Center - Santa Ana

  • Federally Qualified Health Center (FQHC)
  • Santa Ana, CA
National Provider Identifier
1851325906
Registry record updated Nov 4, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNIVERSITY OF CALIFORNIA IRVINE
Doing business as
UCI Family Health Center - Santa Ana
Practice address
800 N Main St
Santa Ana, CA 92701
Phone
(714) 456-6785
NPI assigned
Jul 11, 2006
Last updated
Nov 4, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
UC IRVINE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2019

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

Authorized official

Name
Gina Churchill
Title
Reimbursement Director
Phone
(714) 509-6266

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X CA Primary
Infusion Therapy Clinic/Center 261QI0500X CA

Addresses

Primary practice location

800 N Main St
Santa Ana, CA 92701

Mailing address

1500 S Douglass Rd #200, RT 183
Anaheim, CA 92806-6912
Phone (714) 509-6266

Other names 1

  • UCI Family Health Center - Santa Ana Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031107000431 CA Part B Supplier - Clinic/Group Practice 5395658181 Receives reassigned benefits from 247 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anaheim, CA; Costa Mesa, CA; Irvine, CA; Santa Ana, CA
O20111111000705 CA Part A Provider - Federally Qualified Health Center (FQHC) 5395658181 1 other NPI on this enrollment
Practice locations: Santa Ana, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851325906. Details of each certification follow.

Federally qualified health center certification: CCN 051893

Legal name
UNIVERSITY OF CALIFORNIA IRVINE
Doing business as
UCI FAMILY HEALTH CENTER SANTA ANA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 1, 1993
Last certification
May 1, 1993
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jun 18, 1868 in CA
Enrollment address
800N Main St
Santa Ana, CA 92701-3576

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Regents of the University of California42 organizations share this tax ID, including this one
Part of
Regents of the University of California

Other organizations with this tax ID 41

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

View all 41

Locations

2141 W La Palma Ave
Ste 100
Anaheim, CA 92801

2100 Medical Plz Dr
Bldg 820
Irvine, CA 92697

4000 MacArthur Blvd
Ste 110
Newport Beach, CA 92660
Phone (949) 445-8768

101 The City Dr S
Fl 2
Orange, CA 92868
Phone (714) 456-5547

101 The City Dr S
Ste 715E
Orange, CA 92868

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Randolph Peseverance Siwabessy Individual Corporate DirectorChief Financial Officer May 10, 2021 100%
W-2 Managing EmployeeChief Financial Officer May 10, 2021 100%
Operational/Managerial ControlChief Financial Officer May 10, 2021 100%
Rennie Horneman Individual Corporate DirectorBoard of Directors Sep 26, 2022 1%
Michael a Jaimes Individual Corporate DirectorChairperson - FQHC Board Jan 1, 2008 1%
Gina L Churchill Individual W-2 Managing EmployeeReimbursement Director Jul 1, 2015 5%
Pablo Velasquez Individual Corporate DirectorBoard of Directors Nov 21, 2022 1%
Lauren Irving Individual Corporate DirectorSecretary Jul 1, 2018 1%
University of California Irvine Organization, Orange, CA Non-profit 5% Or Greater Direct Ownership Interest May 1, 1993 100%
Luisa Ruiz Individual Corporate DirectorBoard Member - FQHC Board May 1, 2016 1%
Chad Thurman Lefteris Individual Corporate DirectorChief Operating Officer Jul 1, 2019 100%
Operational/Managerial ControlChief Operating Officer Jul 1, 2016 100%
Jeffrey Page Individual Corporate DirectorBoard Member - FQHC Board May 1, 2016 1%
Anna Ramirez Individual Corporate Director Jul 1, 2018 1%
Howard Aaron Gillman Individual Corporate OfficerChancellor Jul 1, 2016 100%
Operational/Managerial ControlChancellor Jul 1, 2016 100%
Stephanie Resendiz Individual Corporate Director Nov 5, 2018 1%
John J Terrones Individual Corporate DirectorMember at Large Jan 22, 2018 1%

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Uci HealthOrange, CA, CCN 050348 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 1974
Aug 1, 1974
University of California Irvine Medical CenterOrange, CA, CCN 05S348 Hospital 5% Or Greater Direct Ownership Interest Nov 19, 2007
University of California Irvine Medical CenterOrange, CA, CCN 05T348 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Uci Health - Los AlamitosLos Alamitos, CA, CCN 050551 Hospital Operational/Managerial Control (100%) Mar 26, 2024
Uci Health - LakewoodLakewood, CA, CCN 050581 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 26, 2024
Mar 26, 2024
Uci Family Health Center-Santa AnaSanta Ana, CA, CCN 551965 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Mar 20, 2004
Mar 20, 2004

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 65

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 65

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572825600000",
    "number": "1851325906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S DOUGLASS RD #200, RT 183",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928066912",
            "telephone_number": "714-509-6266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N MAIN ST",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "92701",
            "telephone_number": "714-456-6785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF CALIFORNIA IRVINE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UC IRVINE MEDICAL CENTER",
        "enumeration_date": "2006-07-11",
        "last_updated": "2019-11-04",
        "status": "A",
        "authorized_official_last_name": "CHURCHILL",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "REIMBURSEMENT DIRECTOR",
        "authorized_official_telephone_number": "714-509-6266"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCI Family Health Center - Santa Ana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.