NPIMap

Organization Active NPI

Altamed Health Services Corp

Doing business as AltaMed Medical and Dental Group - El Monte

  • Federally Qualified Health Center (FQHC)
  • El Monte, CA
National Provider Identifier
1982814745
Registry record updated Aug 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
FHC70619F Issued in CA
Legal business name
ALTAMED HEALTH SERVICES CORP
Doing business as
AltaMed Medical and Dental Group - El Monte
Practice address
10418 East Valley Blvd
Suite B
El Monte, CA 91731-3600
Phone
(626) 453-8466
Fax
(626) 453-8465
NPI assigned
May 23, 2007
Last updated
Aug 16, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2019

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X FHC70619F CA Primary

Addresses

Primary practice location

10418 East Valley Blvd
Suite B
El Monte, CA 91731-3600

Mailing address

2040 Camfield Ave
Los Angeles, CA 90040-1501
Phone (323) 725-8751

Other names 1

  • AltaMed Medical and Dental Group - El Monte Doing business as

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20100623000534 WI Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 Practice locations: El Monte, CA
O20210607002844 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: El Monte, CA
O20210608002342 CA Part A Provider - Federally Qualified Health Center (FQHC) 4284539966 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pasadena, CA

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1982814745. Details of each certification follow.

Federally qualified health center certification: CCN 051984

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL AND DENTAL GROUP- EL MONTE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 5, 1996
Last certification
Feb 5, 1996
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
10418 East Valley Blvd
Suite B
El Monte, CA 91731-3600

Federally qualified health center certification: CCN 921967

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-EL MONTE,SANTA ANITA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 7, 2021
Last certification
Jun 7, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
3208 Santa Anita Ave
Suite 200
El Monte, CA 91733-1304

Federally qualified health center certification: CCN 921968

Legal name
ALTAMED HEALTH SERVICES CORP
Doing business as
ALTAMED MEDICAL GROUP-PASADENA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 8, 2021
Last certification
Jun 8, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 21, 1970 in CA
Enrollment address
2661 E Washington Blvd
Pasadena, CA 91107-1412

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 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Maria Grimaldo Individual Corporate DirectorConsumer Board Member Oct 29, 2013
Jose Avalos Individual Corporate DirectorBoard Vice Chairman Jun 28, 2018
Adolfo O Chanez Individual Corporate DirectorBoard Member Feb 25, 2016
Castulo de la Rocha Individual Corporate OfficerPresident & Ceo Mar 1, 1997
Corporate OfficerPresident & Ceo Mar 1, 1977
Marc Victor Individual Corporate DirectorInterim Board Treasurer Oct 26, 2017
Sarkis Karakesisoglu Individual Corporate DirectorConsumer Board Member Oct 23, 2020
Ricardo Robles Individual Corporate DirectorBoard Secretary Jan 22, 2015
Victor Olmos Individual Corporate DirectorBoard Member Oct 23, 2020
Joseph Gomez Individual Corporate DirectorConsumer Board Member Sep 6, 2019
Jose Ubaldo Esparza Individual Corporate OfficerSr. Vice President of Finance & Cfo Jan 20, 1994
Corporate OfficerSr VP of Finance & Cfo Jan 20, 1994
Robert Young Individual W-2 Managing EmployeeVP, Patient Financial Services Jan 5, 2009
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 DirectorConsumer Board Member Oct 25, 2019
Hector Barreto Individual Corporate DirectorBoard Chairman Sep 6, 2019

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565913600000",
    "number": "1982814745",
    "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": "323-725-8751",
            "fax_number": "323-889-7843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10418 EAST VALLEY BLVD",
            "address_2": "SUITE B",
            "city": "EL MONTE",
            "state": "CA",
            "postal_code": "917313600",
            "telephone_number": "626-453-8466",
            "fax_number": "626-453-8465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTAMED HEALTH SERVICES CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2019-08-16",
        "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": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "FHC70619F",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AltaMed Medical and Dental Group - El Monte",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "AltaMed Medical and Dental Group - El Monte",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Monte, CA

Sources for this page

Verify at the official NPI Registry.