NPIMap

Organization Active NPI

Southern California Medical Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Woodland Hills, CA
National Provider Identifier
1861255143
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Practice address
20011 Ventura Blvd # 1002
Woodland Hills, CA 91364-2573
Phone
(818) 528-9525
NPI assigned
Jan 31, 2024
Last updated
Jan 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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

Authorized official

Name
Sheila Busheri
Title
Ceo
Phone
(818) 582-3189

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Non-Surgical Family Planning Clinic/Center 261QF0050X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

20011 Ventura Blvd # 1002
Woodland Hills, CA 91364-2573

Mailing address

PO Box 436
Van Nuys, CA 91408-0436
Phone (818) 650-6700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241002000388 CA Part A Provider - Federally Qualified Health Center (FQHC) 2769666817 Practice locations: Woodland Hills, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861255143. Details of each certification follow.

Federally qualified health center certification: CCN A01885

Legal name
SOUTHERN CALIFORNIA MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2024
Last certification
Oct 1, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 5, 2008 in CA
Enrollment address
20011 Ventura Blvd
Woodland Hills, CA 91364-2573

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Southern California Medical4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Southern California Medical Center Inc Organization, Van Nuys, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 5, 2008 100%
John Pazirandeh Individual Corporate OfficerChief Financial Officer May 15, 2022
Nancy Mejia Individual W-2 Managing EmployeeSr. Operation Manager Mar 14, 2022
Steven Sanzo Individual Corporate OfficerChief Development Officer Jan 4, 2021
Ara Baghdasarian Individual Corporate OfficerChief Executive Officer May 1, 2022
Allen Hassen Individual Corporate OfficerChief Medical Officer Nov 1, 2024
Ellie Zare Individual W-2 Managing EmployeeSr. Operation Manager Jan 1, 2022
Lien Trinh Tran Individual W-2 Managing EmployeeCmo Assistant Feb 1, 2018
Naveed Torian Individual Other Jan 1, 2011

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Southern California Medical Center-Pico RiveraPico Rivera, CA, CCN 751049 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 5, 2008
Southern California Medical CenterEl Monte, CA, CCN 751966 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 5, 2008
Southern California Medical Center IncVan Nuys, CA, CCN 751943 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 1, 2011
Southern California Medical Center IncPomona, CA, CCN 921873 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 22, 2020
Southern California Medical CenterLong Beach, CA, CCN 921960 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) May 5, 2008

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1706659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1861255143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 436",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914080436",
            "telephone_number": "818-650-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20011 VENTURA BLVD # 1002",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913642573",
            "telephone_number": "818-528-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-31",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "BUSHERI",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-582-3189"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland Hills, CA

Sources for this page

Verify at the official NPI Registry.