NPIMap

Organization Active NPI

Santa Barbara Neighborhood Clinics

  • Federally Qualified Health Center (FQHC)
  • Santa Barbara, CA
National Provider Identifier
1063438232
Registry record updated Mar 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
050000113 Issued in CA
Legal business name
SANTA BARBARA NEIGHBORHOOD CLINICS
Practice address
915 N Milpas St
Santa Barbara, CA 93103-2331
Phone
(805) 963-1641
Fax
(805) 962-6616
NPI assigned
Jul 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2016

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

Authorized official

Name
Dr. Charles Camillo Fenzi, M.D.
Title
Chief Executive Officer
Phone
(805) 617-7850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 050000113 CA Primary

Addresses

Primary practice location

915 N Milpas St
Santa Barbara, CA 93103-2331

Mailing address

915 N Milpas St
2ND Floor
Santa Barbara, CA 93103-2331
Phone (805) 617-7858

Other identifiers 9

IdentifierTypeStateIssuer
050000113OtherCACOMMUNITY CLINIC LICENSE
HAP70114GOtherCAFAMPACT LEGACY NUMBER
BCP70114GOtherCACDP PROVIDER NUMBER
EAP70114GOtherCAEAPC PROVIDER NUMBER
CLP 303897OtherCADHS LAB REGISTRATION NUMBER
168904OtherCACCS
05D0584453OtherCACLIA NUMBER
CLN 1072OtherCABOARD OF PHARMACY CLINIC PERMIT
FHC70114GMedicaidCA

Other names 1

  • Eastside Neighborhood Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041216001047 CA Part B Supplier - Clinic/Group Practice 3870550247 Receives reassigned benefits from 45 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Santa Barbara, CA; Isla Vista, CA; Goleta, CA
O20110915000763 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870550247 Practice locations: Santa Barbara, CA

Federally qualified health center certification: CCN 551100

Legal name
SANTA BARBARA NEIGHBORHOOD CLINICS
Doing business as
EASTSIDE NEIGHBORHOOD CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 24, 2011
Last certification
Jan 24, 2011
Ownership / control type
Non-profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1998 in CA
Enrollment address
915 N Milpas St
Santa Barbara, CA 93103-2331

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

2320 Bath St
Santa Barbara, CA 93105
Phone (805) 569-1164

1900 State St
Santa Barbara, CA 93101

923 N Milpas St
Santa Barbara, CA 93103
Phone (805) 884-1998

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Gerardo Menchaca Fajardo Individual Corporate DirectorVice Chair Jun 26, 2013
Ceylan Ozkan Individual Corporate OfficerCco Aug 1, 2023
W-2 Managing EmployeeCco Aug 1, 2023
Marie Nikki Rickard Individual Corporate DirectorBoard Member Feb 27, 2013
Teresa Alvarez Individual Corporate DirectorTreasurer Apr 24, 2024
Melinda Stavely Individual Corporate DirectorBoard Member Apr 23, 2011
Heather Silva Individual Corporate DirectorBoard Secretary Dec 18, 2024
Brian G Gough Individual Corporate DirectorBoard Member Jan 2, 2021
Brian Knowles Individual Corporate DirectorBoard Member Mar 28, 2012
Christopher V Lambert Individual Corporate DirectorChairperson Sep 22, 2021
Teresa Anis Individual Corporate DirectorBoard Member Dec 18, 2024
James L Armstrong Individual Corporate DirectorBoard Member Aug 26, 2021
Don Lafler Individual Corporate DirectorBoard Member Apr 22, 2020
Ali Valipour Individual Corporate DirectorBoard Member Mar 23, 2023
Paul Jaconette Individual Corporate DirectorBoard Member Jan 28, 2012
Hugh Boss Individual Corporate DirectorBoard Member Sep 25, 2024
Lynn M Fitzgibbons Individual Corporate DirectorBoard Member Sep 21, 2021

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 62

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456963200000",
    "number": "1063438232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 N MILPAS ST",
            "address_2": "2ND FLOOR",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931032331",
            "telephone_number": "805-617-7858",
            "fax_number": "805-898-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 N MILPAS ST",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931032331",
            "telephone_number": "805-963-1641",
            "fax_number": "805-962-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA BARBARA NEIGHBORHOOD CLINICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2016-03-03",
        "status": "A",
        "authorized_official_last_name": "FENZI",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "CAMILLO",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "805-617-7850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "050000113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY CLINIC LICENSE",
            "identifier": "050000113",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMPACT LEGACY NUMBER",
            "identifier": "HAP70114G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDP PROVIDER NUMBER",
            "identifier": "BCP70114G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC PROVIDER NUMBER",
            "identifier": "EAP70114G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHS LAB REGISTRATION NUMBER",
            "identifier": "CLP 303897",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCS",
            "identifier": "168904",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "05D0584453",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF PHARMACY CLINIC PERMIT",
            "identifier": "CLN 1072",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70114G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Neighborhood Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Barbara, CA

Sources for this page

Verify at the official NPI Registry.