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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

TRI-STATE COMMUNITY HEALTHCARE CENTER
NPI 1508379017
Clinic/Center - Federally Qualified Health Center (FQHC) in Adelanto, CA

Active since November 07, 2017CLIA Certified · 6 labs
11499 BARTLETT AVE, ADELANTO, CA 92301(760) 444-4258 Get Directions Write a Review

NPPES record last updated: September 21, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Sep 21, 2026, Jun 30, 2025, Jun 24, 2025 and 9 more (12 updates tracked since 2017).

About Tri-state Community Healthcare Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRI-STATE COMMUNITY HEALTHCARE CENTER (NPI 1508379017) is a healthcare organization registered as a federally qualified health center (fqhc) in Adelanto, California and active in the NPI registry since November 2017. The organization holds 6 active CLIA laboratory certificates, maintains 10 additional practice locations, and lists Crystale Mineros, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1508379017
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameTRI-STATE COMMUNITY HEALTHCARE CENTER
Location Address11499 BARTLETT AVEAdelanto, CA 92301-1902
Mailing Address1535 E Colorado StGlendale, CA 91205-1513
Phone(760) 444-4258
Organization SubpartYes
Authorized OfficialCrystale MinerosCredentialing Manager · (909) 575-7161
Enumeration DateNovember 7, 2017
Last NPPES UpdateSeptember 21, 202612 updates tracked since enumeration
NPPES CertifiedSeptember 21, 2026
✔ NPI 1508379017 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedClinic/Center · Primary CareTaxonomy 261QP2300X
11499 BARTLETT AVE, Adelanto, CA 92301
Open in Google Maps ↗

Secondary Practice Locations 10

Location 1540 N San Jacinto St Ste PHemet, CA 92543-3154 · Phone (951) 929-4000 · Fax (951) 929-4100
Location 26630 Crenshaw BlvdLos Angeles, CA 90043-4102 · Phone (213) 686-1517 · Fax (213) 686-1518
Location 31061 E Vernon Ave Ste FLos Angeles, CA 90011-3772 · Phone (323) 233-9686 · Fax (323) 233-0595
Location 43600 E 1st StLos Angeles, CA 90063-2326 · Phone (323) 694-0911 · Fax (323) 694-0900
Location 5540 N San Jacinto St Ste IHemet, CA 92543-3154 · Phone (951) 651-1006
Location 61532 San Bernardino Ave Ste A2Pomona, CA 91767-3559 · Phone (909) 301-4041 · Fax (909) 301-4042
Location 711273 Laurel Canyon Blvd Ste 2San Fernando, CA 91340-4357 · Phone (818) 853-2220 · Fax (818) 853-2221
Location 81532 San Bernardino Ave Ste B7Pomona, CA 91767-3559 · Phone (909) 301-4041
Location 911888 Bartlett AveAdelanto, CA 92301-1709 · Phone (760) 530-9944 · Fax (760) 530-9977
Location 104137 Verdugo RdLos Angeles, CA 90065-3820 · Phone (323) 344-9255 · Fax (323) 344-8776

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tri-state Community Healthcare Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

72

Medicare enrollment records show 72 clinicians reassign Medicare billing to Tri-State Community Healthcare Center, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 6 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 10

Nurse Practitioner34
Clinical Social Worker11
Marriage and Family Therapist7
Podiatry6
Family Practice5
Dentist3
General Practice2
Optometry2
2 other specialties2

Nearest to this location (20)

See all 72
Aya Abdelaziz
Dentist
NPI 1508595984
11499 BARTLETT AVE
Adelanto, CA 92301
(760) 444-4258
✔ PECOSSame address
Jillian Ross, FNP
Nurse Practitioner
NPI 1538833199
11499 BARTLETT AVE
Adelanto, CA 92301
(760) 444-4258
✔ PECOS✔ Accepts MedicareSame address
Susan Tanner, APRN
Nurse Practitioner
NPI 1932537511
11499 BARTLETT AVE
Adelanto, CA 92301
(760) 444-4258
✔ PECOSSame address
Ouk Hyun Lee
Dentist
NPI 1669950069
11328 BARTLETT AVE STE 2
Adelanto, CA 92301
(760) 237-8848
✔ PECOS0.2 mi
Qianna Liu
Family Practice
NPI 1285121582
11888 BARTLETT AVE
Adelanto, CA 92301
(760) 530-9944
✔ PECOS0.4 mi
Connie Laurent, FNP-C
Nurse Practitioner
NPI 1568195212
12740 HESPERIA RD STE B
Victorville, CA 92395
(760) 713-6969
✔ PECOS✔ Accepts Medicare9.7 mi
Sam Som, FNP-C
Nurse Practitioner
NPI 1316084312
17330 BEAR VALLEY RD SUITE A 106
Victorville, CA 92395
(760) 245-9999
✔ PECOS10 mi
Roxanne Barbe
Nurse Practitioner
NPI 1346779378
17043 MAIN ST
Hesperia, CA 92345
(760) 241-6666
✔ PECOS✔ Accepts Medicare13 mi
Maria Ruiz-Rodriguez
Nurse Practitioner
NPI 1356846281
850 W HIGHLAND AVE STE A
San Bernardino, CA 92405
(909) 886-7576
✔ PECOS31 mi
Treniese Gill, FNP
Nurse Practitioner
NPI 1568953487
750 E MAIN ST
Barstow, CA 92311
(442) 347-2800
✔ PECOS✔ Accepts Medicare32 mi
Alexander Rodgers, M.D.
Family Practice
NPI 1396157103
9961 SIERRA AVE # MOB1
Fontana, CA 92335
(909) 223-1906
✔ PECOS35 mi
Ethan Chen, MD
Family Practice
NPI 1073170312
9961 SIERRA AVE
Fontana, CA 92335
(909) 427-2070
✔ PECOS✔ Accepts Medicare35 mi
Verenice Navarro-Gomez, LCSW
Clinical Social Worker
NPI 1396267134
1907 BOYS REPUBLIC DR
Chino Hills, CA 91709
(909) 628-1217
✔ PECOS44 mi
Jarnail Gugga, M.D.
Internal Medicine
NPI 1598769846
741 S ORANGE AVE FL 1
West Covina, CA 91790
(626) 338-8484
✔ PECOS46 mi
Ebram Abdelmalak, DPM
Podiatry
NPI 1225412000
3503 LEXINGTON AVE
El Monte, CA 91731
(310) 343-0820
✔ PECOS✔ Accepts Medicare50 mi
Abdul Ansari
Dermatology
NPI 1124655170
21634 RETREAT PKWY
Corona, CA 92883
(951) 782-3818
✔ PECOS✔ Accepts Medicare54 mi
Renee Williams, LMFT
Marriage and Family Therapist
NPI 1184898355
1560 E CHEVY CHASE DR STE 130
Glendale, CA 91206
(818) 240-0340
✔ PECOS55 mi
Arra Apikian, OD
Optometry
NPI 1528726924
4137 VERDUGO RD
Los Angeles, CA 90065
(323) 344-9255
✔ PECOS56 mi
Lesley Carrillo, DMD
Dentist
NPI 1225760358
2975 ZOE AVE
Huntington Park, CA 90255
(323) 826-9449
✔ PECOS62 mi
Mark Folmsbee, D.O.
General Practice
NPI 1427393123
732 MOTT ST STE 100-110
San Fernando, CA 91340
(818) 963-5690
✔ PECOS✔ Accepts Medicare62 mi
See all 72 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 6

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2172975

Tri-State Community Healthcare Center · Los Angeles, CA
Active · expires Oct 1, 2027
CLIA Number05D2172975
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateOctober 2, 2025
Certificate Expiration DateOctober 1, 2027
Laboratory DirectorShahram S. Mirhashemi
Laboratory Phone(323) 344-9255
Laboratory LocationTri-State Community Healthcare Center4137 Verdugo Road, Los Angeles, CA 90065
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2285000

Tri-State Community Healthcare Center · San Fernando, CA
Active · expires Jul 2, 2027
CLIA Number05D2285000
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJuly 3, 2025
Certificate Expiration DateJuly 2, 2027
Laboratory DirectorJose L. Perez
Laboratory Phone(818) 853-2220
Laboratory LocationTri-State Community Healthcare Center11273 Laurel Canyon Blvd Suite 2, San Fernando, CA 91340
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2316911

Tri-State Community Healthcare Center · Los Angeles, CA
Active · expires Jan 13, 2027
CLIA Number05D2316911
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateJanuary 14, 2025
Certificate Expiration DateJanuary 13, 2027
Laboratory DirectorShahram Mirhashemi
Laboratory Phone(323) 694-0911
Laboratory LocationTri-State Community Healthcare Center3600 E 1st St, Los Angeles, CA 90063
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2273167

Tri-State Community Healthcare Center · Pomona, CA
Active · expires Dec 6, 2026
CLIA Number05D2273167
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateDecember 7, 2024
Certificate Expiration DateDecember 6, 2026
Laboratory DirectorShahram S. Mirhashemi
Laboratory Phone(909) 301-4041
Laboratory LocationTri-State Community Healthcare Center1532 San Bernardino Ave Suite B7, Pomona, CA 91767
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2271454

Tri-State Community Healthcare Center · Adelanto, CA
Active · expires Nov 1, 2026
CLIA Number05D2271454
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateNovember 2, 2024
Certificate Expiration DateNovember 1, 2026
Laboratory DirectorEdward T. Paget
Laboratory Phone(760) 530-9944
Laboratory LocationTri-State Community Healthcare Center11499 Bartlett Ave, Adelanto, CA 92301
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 05D2295580

Tristate Community Healthcare Center · Pomona, CA
Active · expires Dec 12, 2027
CLIA Number05D2295580
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateDecember 13, 2025
Certificate Expiration DateDecember 12, 2027
Laboratory DirectorShahram Mirhashemi
Laboratory Phone(909) 301-4041
Laboratory LocationTristate Community Healthcare Center1532 San Bernadino Ave Suite A2, Pomona, CA 91767
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tri-State Community Healthcare Center's NPI number?

The NPI number for Tri-State Community Healthcare Center is 1508379017. It was assigned to this organization in the NPPES registry on November 7, 2017.

Where is Tri-State Community Healthcare Center located?

Tri-State Community Healthcare Center is located at 11499 Bartlett Ave, Adelanto, CA 92301. The listed phone number is (760) 444-4258.

What is Tri-State Community Healthcare Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Is Tri-State Community Healthcare Center enrolled in Medicare?

Yes. Tri-State Community Healthcare Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Tri-State Community Healthcare Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 72 clinicians in 10 Medicare specialties reassign their Medicare billing to Tri-State Community Healthcare Center. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (34), Clinical Social Worker (11) and Marriage and Family Therapist (7). Of these, 3 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Tri-State Community Healthcare Center hold CLIA laboratory certificates?

Yes. 6 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Tri-State Community Healthcare Center was last updated on September 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 31 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.