NPIMap

Organization Active NPI

Altamed Health Services Corp

Doing business as AltaMed Medical Group-Westlake, 3rd Street

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1902453731
Registry record updated Aug 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ALTAMED HEALTH SERVICES CORP
Doing business as
AltaMed Medical Group-Westlake, 3rd Street
Practice address
2100 W 3Rd St Ste 400
Los Angeles, CA 90057-2290
Phone
(888) 499-9303
NPI assigned
Aug 26, 2019
Last updated
Aug 26, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2019

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

Authorized official

Name
Robert U. Young, MD
Title
VP, Patient Financial Services
Phone
(323) 622-2429

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2100 W 3Rd St Ste 400
Los Angeles, CA 90057-2290

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (888) 499-9303

Other names 1

  • AltaMed Medical Group-Westlake, 3rd Street Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200701001256 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902453731. Details of each certification follow.

Federally qualified health center certification: CCN 921941

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-NORTHGATE MARKET, OLYMPIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 23, 2020
Last certification
Jun 23, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
2323 W Olympic Blvd
Ste 102
Los Angeles, CA 90006-2011

Other NPIs with the same Medicare PAC ID 22

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

View all 22

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
05D2183500Altamed Medical Group - Northgate Market,2323 West Olympic Blvd Suite 102, Los Angeles, CA 90006Certificate of waiverMay 5, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Robert Rodriguez Individual Corporate DirectorConsumer Board Member Jan 1, 2024
Castulo de la Rocha Individual Corporate OfficerPresident & Ceo Mar 1, 1977
Marc Victor Individual Corporate DirectorSecretary, Board Member Oct 26, 2017
Ricardo Robles Individual Corporate DirectorChair, Consumer Board Member Jan 22, 2015
Victor Olmos Individual Corporate DirectorTreasurer, Board Member Oct 23, 2020
Jay P Lee Individual Corporate DirectorBoard Member Jan 1, 2024
Maria Cervantes Individual Corporate DirectorBoard Member Aug 28, 2018
Joseph Gomez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Jose Ubaldo Esparza Individual Corporate OfficerEvp Finance and Cfo Jan 20, 1994
Robert Young Individual W-2 Managing EmployeeVP, Patient Financial Services Jan 5, 2009
Nadia Paola Alvarez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Lucy Maria Herrera Individual Corporate DirectorVice Chair, Consumer Board Member Nov 5, 2019

NPI Registry JSON

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

{
    "created_epoch": "1566777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566777600000",
    "number": "1902453731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 CAMFIELD AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900401501",
            "telephone_number": "888-499-9303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W 3RD ST STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572290",
            "telephone_number": "888-499-9303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-26",
        "last_updated": "2019-08-26",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "U.",
        "authorized_official_title_or_position": "VP, PATIENT FINANCIAL  SERVICES",
        "authorized_official_telephone_number": "323-622-2429",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AltaMed Medical Group-Westlake, 3rd Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.