Mitesh G Popat, MD
Individual provider Active NPI Family Medicine Physician · Venice, CA
NPI 1104057397 · NPPES record last updated Mar 21, 2023
Key facts
- NPI
- 1104057397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- A107005 (CA)
- Practice address
- 604 Rose Ave
Venice, CA 90291-2767 - Phone
- (310) 392-8636
- NPI assigned
- Aug 5, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 17
Owned or controlled facilities with NPI records 21
Medicare Care Compare profile
- 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 Clinic
Practice addresses (Care Compare)
604 Rose Ave
Venice, CA 90291-2767
Phone (310) 664-7901
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 21
| Facility | Type | Role | Since |
|---|---|---|---|
| Marin Community Clinic |
Federally qualified health center | Corporate Officer | Nov 1, 2013 |
| Marin Community Clinics |
Federally qualified health center | 5% Or Greater Indirect Ownership Interest (5%) Corporate Director |
Jul 15, 2017 Jul 1, 2017 |
| Venice Family Clinic Irma Colen |
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 Clinic |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 22, 2022 Dec 22, 2022 |
| Venice Family Clinic |
Federally qualified health center | Corporate Officer Operational/Managerial Control (50%) |
Dec 22, 2022 Dec 12, 2022 |
| Venice Family Clinic |
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 Youth |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 12, 2022 Dec 12, 2022 |
| Venice Family Clinic-Santa Monica High School |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 12, 2022 Dec 12, 2022 |
| Opcc Annenberg Access Center |
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 Center |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 12, 2022 Dec 12, 2022 |
| Marin Community Clinics |
Federally qualified health center | Corporate Officer (25%) | Dec 1, 2016 |
| Venice Family Clinic |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 12, 2022 Dec 12, 2022 |
| Venice Family Clinic - South Bay Family Health Care - Inglewood |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 12, 2022 Dec 12, 2022 |
| Venice Family Clinic |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 12, 2022 Dec 12, 2022 |
| Venice Family Clinic |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 12, 2022 Dec 12, 2022 |
| Marin Community Clinic |
Federally qualified health center | Corporate Officer (5%) | Jul 1, 2020 |
| Venice Family Clinic - Common Ground at Judy & Bernard Briskin Center |
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 Center |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Dec 12, 2022 Dec 12, 2022 |
| Venice Family Clinic - Meyer Mobile Clinic |
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- Allcove |
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 Center |
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 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141209002501 | CA | Order and Referring Only - Family Practice |
8820287923 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 107005 | CA | MD | General Practice Dentistry |
Practice roles (1 of 2)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Venice Family Clinic | Past |
Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- mitesh.popat.p1@direct.venicefamilyclinic.nextgenshare.com
- mpopat753704@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A107005 | CA | Yes |
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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Mitesh.popat.p1@direct.venicefamilyclinic.nextgenshare.com | Direct |
Other providers in Venice, CA
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- Caron Sue Post
- Heidi Potter
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All providers in Venice, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2023. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.