NPIMap

Organization Active NPI

North East Medical Services

  • Federally Qualified Health Center (FQHC)
  • San Francisco, CA
National Provider Identifier
1942844477
Registry record updated Mar 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTH EAST MEDICAL SERVICES
Practice address
650 Polk St
San Francisco, CA 94102-3328
Phone
(415) 391-9686
NPI assigned
Oct 28, 2019
Last updated
Mar 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2022

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

Authorized official

Name
Mr. Eddie W Chan, PHARMD
Title
President & Ceo
Phone
(415) 391-9686

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Supports Brokerage Agency 251X00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

650 Polk St
San Francisco, CA 94102-3328

Mailing address

2171 Junipero Serra Blvd Ste 260
Daly City, CA 94014-1986
Phone (415) 391-9686

Other names 1

  • North East Medical Services - Polk Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040224001157 CA Part B Supplier - Clinic/Group Practice 4284520529 Receives reassigned benefits from 183 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Francisco, CA; South San Francisco, CA; San Jose, CA; Daly City, CA
O20191024003333 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284520529 1 other NPI on this enrollment
Practice locations: San Francisco, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942844477. Details of each certification follow.

Federally qualified health center certification: CCN 921818

Legal name
NORTH EAST MEDICAL SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 16, 2019
Last certification
Oct 16, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 6, 1968 in CA
Enrollment address
650 Polk St
San Francisco, CA 94102-3328

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

Other NPIs on the same Medicare enrollment 20

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

View all 20

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
05D2167264North East Medical Services Ellis Clinic Lab650 Polk St, San Francisco, CA 94102Certificate of waiverJun 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
North East Medical57 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Locations

650 Polk St
San Francisco, CA 94102

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Anne Brandon Individual Corporate DirectorBoard Chair Feb 10, 1993
Siu Han Cheung Individual Corporate DirectorBoard Member Jan 24, 2013
Alan Khoo Individual Corporate DirectorBoard Member Apr 27, 2023
Eunice Hendary Individual Corporate DirectorBoard Member Feb 28, 2013
John Jin Lee Individual Corporate DirectorBoard Member Apr 25, 2004
Edwin Wang Individual Corporate OfficerBoard Member Dec 18, 2003
North East Medical Services Organization, San Francisco, CA Corporation, Non-profit Operational/Managerial Control Jun 1, 2020 100%
Nancy Huang Individual Corporate DirectorBoard Vice-Chair Jan 1, 1993
Jeany Tay Individual Corporate DirectorBoard Member Jan 23, 2014
Albert Yue Individual Corporate DirectorBoard Member Oct 24, 2019
Eddie W Chan Individual Corporate OfficerPresident & Ceo Jul 21, 2008
W-2 Managing EmployeePresident & Ceo Jul 21, 2008
Mike CHI Individual Corporate DirectorBoard Secretary-Treasurer Jan 1, 1989
Johnson Wong Individual Corporate OfficerChief Financial Officer Sep 2, 2008
W-2 Managing EmployeeChief Financial Officer Sep 2, 2008

Owners & managing parties with NPI records 23

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

View all 23

All facility ownership & control disclosures 18

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

FacilityTypeRoleSince
North East Medical ServicesSan Francisco, CA, CCN 551882 Federally qualified health center Operational/Managerial Control (100%) Jan 1, 2020
North East Medical ServicesSan Francisco, CA, CCN 551007 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2009
North East Medical ServicesSan Francisco, CA, CCN 551092 Federally qualified health center Operational/Managerial Control (100%) May 1, 2011
North East Medical ServicesDaly City, CA, CCN 551109 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2011
North East Medical ServicesSan Francisco, CA, CCN 551162 Federally qualified health center Operational/Managerial Control (100%) Jan 25, 2012
North East Medical ServicesSan Francisco, CA, CCN 551174 Federally qualified health center Operational/Managerial Control (100%) Jan 25, 2012
Nems - 1870 LundySan Jose, CA, CCN 751031 Federally qualified health center Operational/Managerial Control (100%) Aug 31, 2011
Nems - 3431 TaravalSan Francisco, CA, CCN 921819 Federally qualified health center Operational/Managerial Control (100%) Jun 28, 2018
North East Medical ServicesSan Francisco, CA, CCN 921828 Federally qualified health center Operational/Managerial Control (100%) Jun 28, 2018
North East Medical ServicesSan Francisco, CA, CCN A01033 Federally qualified health center Operational/Managerial Control (100%) Feb 27, 2020
North East Medical Services - Medical OncologySan Francisco, CA, CCN A01092 Federally qualified health center Operational/Managerial Control (100%) Apr 28, 2022
North East Medical Services - Sullivan Suite 150Daly City, CA, CCN 921094 Federally qualified health center Operational/Managerial Control (100%) Dec 15, 2022
North East Medical Services - 1430 NoriegaSan Francisco, CA, CCN A01822 Federally qualified health center Operational/Managerial Control (100%) Mar 15, 2023
Nems Traditional Medicine Center - Suite 403San Francisco, CA, CCN A01823 Federally qualified health center Operational/Managerial Control (100%) May 7, 2019
Nems Traditional Medicine Center - Suite 503San Francisco, CA, CCN A01828 Federally qualified health center Operational/Managerial Control (100%) May 7, 2019
North East Medical Services - Las VegasLas Vegas, NV, CCN 291019 Federally qualified health center Operational/Managerial Control (100%) Apr 10, 2023
North East Medical Services - 939 Story RoadSan Jose, CA, CCN A11049 Federally qualified health center Operational/Managerial Control (100%) Apr 24, 2025
North East Medical Services - 200 LindenSouth San Francisco, CA, CCN A11050 Federally qualified health center Operational/Managerial Control (100%) Jan 23, 2025

Owned or controlled facilities with NPI records 19

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

View all 19

Facilities with the same owner 18

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

View all 18

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": "1572220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646697600000",
    "number": "1942844477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2171 JUNIPERO SERRA BLVD STE 260",
            "city": "DALY CITY",
            "state": "CA",
            "postal_code": "940141986",
            "telephone_number": "415-391-9686",
            "fax_number": "415-433-4726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 POLK ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941023328",
            "telephone_number": "415-391-9686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH EAST MEDICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-28",
        "last_updated": "2022-03-08",
        "certification_date": "2022-03-08",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "415-391-9686",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North East Medical Services - Polk",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "North East Medical Services - Polk",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.