NPIMap

Individual provider Active NPI

Mitesh G Popat, MD

  • Family Medicine Physician
  • Venice, CA
National Provider Identifier
1104057397
Registry record updated Mar 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A107005 Issued in CA
Practice address
604 Rose Ave
Venice, CA 90291-2767
Phone
(310) 392-8636
NPI assigned
Aug 5, 2009
Last updated
Mar 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A107005 CA Primary

Addresses

Primary practice location

604 Rose Ave
Venice, CA 90291-2767

Mailing address

604 Rose Ave
Venice, CA 90291-2767
Phone (310) 664-7901

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Mitesh.popat.p1@direct.venicefamilyclinic.nextgenshare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141209002501 CA Order and Referring Only - Family PracticePractitioner - Family Practice 8820287923

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Tufts University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Venice Family ClinicGroup PAC ID 2264339126, shared by 17 NPIs, 101 clinicians

Practice addresses (Care Compare)

604 Rose Ave
Venice, CA 90291-2767
Phone (310) 664-7901

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A107005CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Venice Family Clinic PastSince Dec 12, 2022 Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mitesh.popat.p1@direct.venicefamilyclinic.nextgenshare.com
  • Direct secure messaging: mpopat753704@direct.ochin.org

Ownership & related parties

All facility ownership & control disclosures 21

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

FacilityTypeRoleSince
Marin Community ClinicNovato, CA, CCN 051945 Federally qualified health center Corporate Officer Nov 1, 2013
Marin Community ClinicsSan Rafael, CA, CCN 551104 Federally qualified health center 5% Or Greater Indirect Ownership Interest (5%)
Corporate Director		 Jul 15, 2017
Jul 1, 2017
Venice Family Clinic Irma ColenCulver City, CA, CCN 751800 Federally qualified health center Corporate Officer (10%)
W-2 Managing Employee (10%)
Operational/Managerial Control (10%)		 Dec 12, 2022
Dec 12, 2022
Dec 12, 2022
Venice Family ClinicVenice, CA, CCN 751198 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 22, 2022
Dec 22, 2022
Venice Family ClinicVenice, CA, CCN 751801 Federally qualified health center Corporate Officer
Operational/Managerial Control (50%)		 Dec 22, 2022
Dec 12, 2022
Venice Family ClinicSanta Monica, CA, CCN 751808 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Venice Family Clinic-Bills Clinic at Safe Place for YouthVenice, CA, CCN 751948 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Venice Family Clinic-Santa Monica High SchoolSanta Monica, CA, CCN 751960 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Opcc Annenberg Access CenterSanta Monica, CA, CCN 751947 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Venice Family Clinic-Lou Colen Childrens Health and Wellness CenterCulver City, CA, CCN 751955 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Marin Community ClinicsGreenbrae, CA, CCN A01030 Federally qualified health center Corporate Officer (25%) Dec 1, 2016
Venice Family ClinicGardena, CA, CCN 551961 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Venice Family Clinic - South Bay Family Health Care - InglewoodInglewood, CA, CCN 051048 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Venice Family ClinicRedondo Beach, CA, CCN 551960 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Venice Family ClinicCarson, CA, CCN 751055 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Marin Community ClinicSan Rafael, CA, CCN A01145 Federally qualified health center Corporate Officer (5%) Jul 1, 2020
Venice Family Clinic - Common Ground at Judy & Bernard Briskin CenterVenice, CA, CCN A01924 Federally qualified health center Corporate Officer (50%)
W-2 Managing Employee (50%)		 Dec 12, 2022
Dec 12, 2022
Venice Family Clinic - Sandy Segal Youth Health CenterCulver City, CA, CCN A01923 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Dec 12, 2022
Dec 12, 2022
Venice Family Clinic - Meyer Mobile ClinicVenice, CA, CCN A01956 Federally qualified health center Corporate Officer (50%)
W-2 Managing Employee (50%)
Operational/Managerial Control (50%)		 Dec 12, 2022
Dec 12, 2022
Dec 12, 2022
Venice Family Clinic- AllcoveRedondo Beach, CA, CCN A01961 Federally qualified health center Corporate Officer (50%)
W-2 Managing Employee (50%)
Operational/Managerial Control (50%)		 Dec 12, 2022
Dec 12, 2022
Dec 12, 2022
Venice Family Clinic - Maxine Waters Health & Dignity CenterHawthorne, CA, CCN A01962 Federally qualified health center Corporate Officer (50%)
W-2 Managing Employee (50%)
Operational/Managerial Control (50%)		 Dec 12, 2022
Dec 12, 2022
Dec 12, 2022

Owned or controlled facilities with NPI records 21

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

View all 21

Organizations & group practices 32

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1249430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679356800000",
    "number": "1104057397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 ROSE AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912767",
            "telephone_number": "310-664-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 ROSE AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912767",
            "telephone_number": "310-392-8636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPAT",
        "first_name": "MITESH",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-05",
        "last_updated": "2023-03-21",
        "certification_date": "2023-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A107005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mitesh.popat.p1@direct.venicefamilyclinic.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "604 Rose Ave",
            "city": "Venice",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902912767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Venice, CA

Sources for this page

Verify at the official NPI Registry.