NPIMap

Organization Active NPI

Southern California Medical Center, Inc.

  • Community Health Clinic/Center
  • Pico Rivera, CA
National Provider Identifier
1932428828
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Practice address
8825 Whittier Blvd
Pico Rivera, CA 90660-2657
Phone
(818) 421-0809
NPI assigned
May 18, 2010
Last updated
Jun 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Authorized official

Name
Ellie Zare
Title
Sr. Program Manager
Phone
(818) 650-6700

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Clinic/Center 261Q00000X
Community Health Clinic/Center 261QC1500X Primary
Dental Clinic/Center 261QD0000X
Non-Surgical Family Planning Clinic/Center 261QF0050X
Federally Qualified Health Center (FQHC) 261QF0400X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Multi-Specialty Clinic/Center 261QM1300X
Medical Specialty Clinic/Center 261QM2500X
Physical Therapy Clinic/Center 261QP2000X
Primary Care Clinic/Center 261QP2300X
Radiology Clinic/Center 261QR0200X
Urgent Care Clinic/Center 261QU0200X

Addresses

Primary practice location

8825 Whittier Blvd
Pico Rivera, CA 90660-2657

Mailing address

PO Box 436
Van Nuys, CA 91408-0436
Phone (818) 421-0809

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20110607000460 CA Part B Supplier - Clinic/Group Practice 2769666817 Receives reassigned benefits from 48 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Long Beach, CA; Pico Rivera, CA; Van Nuys, CA; El Monte, CA
O20140122000349 CA Part A Provider - Federally Qualified Health Center (FQHC) 2769666817 Practice locations: Pico Rivera, CA
O20210528000768 CA Part A Provider - Federally Qualified Health Center (FQHC) 2769666817 1 other NPI on this enrollment
Practice locations: Long Beach, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1932428828. Details of each certification follow.

Federally qualified health center certification: CCN 751049

Legal name
SOUTHERN CALIFORNIA MEDICAL CENTER INC
Doing business as
SOUTHERN CALIFORNIA MEDICAL CENTER-PICO RIVERA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 3, 2014
Last certification
Feb 3, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 14, 2008 in CA
Enrollment address
8825 Whittier Blvd
Pico Rivera, CA 90660-2657

Federally qualified health center certification: CCN 921960

Legal name
SOUTHERN CALIFORNIA MEDICAL CENTER INC
Doing business as
SOUTHERN CALIFORNIA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 28, 2021
Last certification
May 28, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 5, 2008 in CA
Enrollment address
1627 E Anaheim St
Long Beach, CA 90813-3809

Other NPIs with the same Medicare PAC ID 4

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

Locations

12100 Valley Blvd
Ste 109
El Monte, CA 91732

1631 E Anaheim St
Long Beach, CA 90813

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
Armando Raygoza Individual Corporate OfficerBoard Member Sep 1, 2011
Jose Barraza Individual Corporate OfficerBoard Member Sep 1, 2011
Southern California Medical Center Inc Organization, Van Nuys, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 5, 2008 100%
Sheila Busheri Individual Corporate OfficerCeo Sep 1, 2011
Steven Sanzo Individual Corporate OfficerChief Development Officer Jan 4, 2021
Rebecca Casarotti Individual Operational/Managerial ControlCoo Sep 1, 2011
Ara Baghdasarian Individual Corporate OfficerChief Operation Officer May 1, 2022
Corporate OfficerChief Executive Officer May 1, 2022
James Anderson Individual Corporate OfficerBoard Member Sep 1, 2011
John Pazirandeh Individual Corporate OfficerChief Financial Officer May 15, 2022
Nancy Mejia Individual W-2 Managing EmployeeSr. Operation Manager Jan 1, 2022
Allen Hassen Individual Corporate OfficerChief Medical Officer Nov 1, 2024
Ellie Zare Individual W-2 Managing EmployeeSr. Program Manager Jan 1, 2022

Owners & managing parties with NPI records 5

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
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 Center IncWoodland Hills, CA, CCN A01885 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 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686614400000",
    "number": "1932428828",
    "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": "818-421-0809",
            "fax_number": "562-699-7066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8825 WHITTIER BLVD",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906602657",
            "telephone_number": "818-421-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-18",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A",
        "authorized_official_last_name": "ZARE",
        "authorized_official_first_name": "ELLIE",
        "authorized_official_title_or_position": "SR. PROGRAM MANAGER",
        "authorized_official_telephone_number": "818-650-6700"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "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": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pico Rivera, CA

Sources for this page

Verify at the official NPI Registry.