Aghaby Comprehensive Community Health Center
Organization Active NPI Internal Medicine Physician · Compton, CA
NPI 1922490960 · NPPES record last updated Feb 27, 2015
Key facts
- NPI
- 1922490960
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- AGHABY COMPREHENSIVE COMMUNITY HEALTH CENTER
- Practice address
- 349 W Compton Blvd
Compton, CA 90220-3110 - Phone
- (310) 438-2151
- Fax
- (424) 217-4921
- NPI assigned
- Feb 27, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Nagy P Bebawy, M.D.
- Title
- Chief Executive Officer
- Phone
- (310) 438-2151
Owners & managing parties with NPI records 1
-
Nagy Philips Bebawy, M.D.
Practitioners 8
-
Nagy Philips Bebawy, M.D.
-
Jessica Barragan, N.P.
-
David Bebawy, M.D.
-
Geovanee Santiago Laya, APRN-CNP
-
Aydhe Rojas, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2111272 | Aghaby Comprehensive Community Health Center | Certificate of waiver | Apr 3, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in CA, NV
Federally qualified health center certification: CCN 921811
- Legal name
- AGHABY COMPREHENSIVE COMMUNITY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Nov 8, 2019
- Last certification
- Nov 8, 2019
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 349 W Compton Blvd
Compton, CA 90220-3110
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Motaz M Gerges |
Corporate Director |
Sep 1, 2017 | |
| Marco Guerrero |
Corporate Director |
Sep 1, 2017 | |
| Nagy P Bebawy |
Corporate Officer |
Sep 1, 2017 | 100% |
| W-2 Managing Employee |
Aug 17, 2015 | ||
| Mateo Cardona |
Corporate Director |
Mar 1, 2021 | |
| Aja Silver |
Corporate Director |
Mar 1, 2021 | |
| Myrel Fontejon |
Corporate Director |
Mar 1, 2021 | |
| Benjamin Marshall |
Corporate Director |
Mar 1, 2021 | |
| Bianca Duarte |
Corporate Director |
Sep 26, 2019 | |
| Nasser H Morcos |
Corporate Director |
Sep 1, 2017 | |
| Massoud Akhavi |
Corporate Director |
Sep 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160418002225 | CA | Part B Supplier - Clinic/Group Practice | 3476851817 |
Receives reassigned benefits from 3 practitioners Practice locations: Compton, CA; Huntington Park, CA |
| O20191118002580 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 3476851817 | Practice locations: Compton, CA |
| O20210419002702 | NV | Part B Supplier - Clinic/Group Practice | 3476851817 |
Receives reassigned benefits from 1 practitioner Practice locations: North Las Vegas, NV |
National Provider Directory
Locations
349 W Compton Blvd
Compton, CA 90220
Phone (310) 669-9300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
349 W Compton Blvd
Compton, CA 90220-3110
Mailing address
349 W Compton Blvd
Compton, CA 90220-3110
Phone (310) 438-2151
Other providers in Compton, CA
- Crystal Marie Adams
- Mamiya Lonnett Adams
- Shontanese Adams
- Matthew Adeleke
- Victor K Afriyie
- Aghapy Meddical Group Inc
- Alondra Aguilar Ortiz
- Norma R Aguilar
- Wendy Aguilar
- Charles C Alamah
All providers in Compton, CA · Internal Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.