Altamed Health Services Corp
Organization Active NPI Federally Qualified Health Center (FQHC) · El Monte, CA
NPI 1982814745 · NPPES record last updated Aug 16, 2019
Key facts
- NPI
- 1982814745
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- License
- FHC70619F (CA)
- Legal business name
- ALTAMED HEALTH SERVICES CORP
- 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
- Organization subpart
- No
Authorized official
- Name
- Robert U. Young, M.D.
- Title
- VP, Patient Financial Services
- Phone
- (323) 622-2429
Owners & managing parties with NPI records 1
-
Jose Avalos, M.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 22
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WI, CA
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
- Corporation · Non-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
- Corporation · Non-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
- Corporation · Non-profit
- Incorporated
- Apr 21, 1970 in CA
- Enrollment address
- 2661 E Washington Blvd
Pasadena, CA 91107-1412
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Maria Grimaldo |
Corporate Director |
Oct 29, 2013 | |
| Jose Avalos |
Corporate Director |
Jun 28, 2018 | |
| Adolfo O Chanez |
Corporate Director |
Feb 25, 2016 | |
| Castulo de la Rocha |
Corporate Officer |
Mar 1, 1997 | |
| Corporate Officer |
Mar 1, 1977 | ||
| Marc Victor |
Corporate Director |
Oct 26, 2017 | |
| Sarkis Karakesisoglu |
Corporate Director |
Oct 23, 2020 | |
| Ricardo Robles |
Corporate Director |
Jan 22, 2015 | |
| Victor Olmos |
Corporate Director |
Oct 23, 2020 | |
| Joseph Gomez |
Corporate Director |
Sep 6, 2019 | |
| Jose Ubaldo Esparza |
Corporate Officer |
Jan 20, 1994 | |
| Corporate Officer |
Jan 20, 1994 | ||
| Robert Young |
W-2 Managing Employee |
Jan 5, 2009 | |
| W-2 Managing Employee |
Jan 5, 2009 | ||
| Nadia Paola Alvarez |
Corporate Director |
Sep 6, 2019 | |
| Lucy Maria Herrera |
Corporate Director |
Oct 25, 2019 | |
| Hector Barreto |
Corporate Director |
Sep 6, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | FHC70619F | CA | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| FHC70619F | Medicaid | CA |
Other names
- AltaMed Medical and Dental Group - El Monte
Other providers in El Monte, CA
- Altamed Health Services Corp
- Altamed Health Services Corp
- Altamed Health Services Corp
- Altamed Health Services Corp
- Altamed Health Services Corp
- Altamed Health Services Corp.
- Alondra Altamirano-Casillas
- Jonathan Joaquin Alvarado Padilla
- Bianca Alvarado
- Jasmin Alvarado
All providers in El Monte, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2019. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.