NPIMap

Organization Active NPI

Clinicas del Camino Real Inc

Doing business as Clinicas del Camino Real Inc El Rio

  • Federally Qualified Health Center (FQHC)
  • Oxnard, CA
National Provider Identifier
1134369366
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
550000968 Issued in CA
Legal business name
CLINICAS DEL CAMINO REAL INC
Doing business as
Clinicas del Camino Real Inc El Rio
Practice address
2600 E Vineyard Ave
Oxnard, CA 93036-1615
Phone
(805) 436-3444
Fax
(805) 485-4160
NPI assigned
Feb 27, 2009
Last updated
Jun 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Authorized official

Name
Farhad Benharash
Title
Chief Financial Officer
Phone
(805) 659-1740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550000968 CA Primary

Addresses

Primary practice location

2600 E Vineyard Ave
Oxnard, CA 93036-1615

Mailing address

200 S Wells Rd
Suite 200
Ventura, CA 93004-1377
Phone (805) 659-1740

Other names 1

  • Clinicas del Camino Real Inc El Rio Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040205001238 CA Part B Supplier - Clinic/Group Practice 3173434396 Receives reassigned benefits from 249 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oxnard, CA; Santa Paula, CA; Simi Valley, CA; Ventura, CA; Ojai, CA; Newbury Park, CA; Moorpark, CA; Fillmore, CA…
O20090723000391 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173434396 Practice locations: Oxnard, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134369366. Details of each certification follow.

Federally qualified health center certification: CCN 051172

Legal name
CLINICAS DEL CAMINO REAL INC
Doing business as
CLINICAS DEL CAMINO REAL INC EL RIO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 23, 2009
Last certification
Jul 23, 2009
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1975 in CA
Enrollment address
2600 E Vineyard Ave
Oxnard, CA 93036-1615

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory

Locations

200 S Wells Rd
Ventura, CA 93004
Phone (805) 647-6322

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Kirstin Cady Benites Individual Corporate DirectorSecretary of the Bod Feb 22, 2012 100%
Tim a Hagel Individual Corporate DirectorBoard Member Nov 30, 2020 100%
Charles H Hookstra Individual Corporate DirectorPres/Board of Dirs. Jan 1, 2013
Adolfo Murillo Individual Corporate DirectorVP of the Board of Dirs. Jan 1, 2013
Fred Deharo Individual Corporate OfficerChief Operations Officer Jul 1, 2015
W-2 Managing EmployeeChief Operations Officer Jul 1, 2015
Javier M Ochoa Individual Corporate DirectorParliamentarian of the Board Jan 1, 2013
Farhad Benharash Individual Corporate OfficerChief Financial Officer Mar 1, 2022 100%
W-2 Managing EmployeeChief Financial Officer Mar 1, 2022 100%
Operational/Managerial ControlChief Financial Officer Mar 1, 2022 100%
Gagan Pawar Individual Corporate Officer Apr 1, 2014 100%
W-2 Managing Employee Apr 1, 2014 100%
Operational/Managerial Control Apr 1, 2014 100%
Angel Arreola Individual Corporate DirectorBoard Member Jan 1, 2013
Barbara a Journet Individual Corporate DirectorTreasure of the Board of Dirs. Jan 1, 2013
Robert Cunningham Streeter Individual Corporate OfficerChief Medical Officer Aug 15, 2022 100%
W-2 Managing EmployeeChief Medical Officer Aug 15, 2022 100%
Operational/Managerial ControlChief Medical Officer Aug 15, 2022 100%
Kathryn G Adams Individual Corporate OfficerChief Human Resources Officer Jul 25, 2022 100%
W-2 Managing EmployeeChief Human Resources Officer Jul 25, 2022 100%
Operational/Managerial ControlChief Human Resources Officer Jul 25, 2022 100%
Anna Bell Monroy Individual Corporate OfficerChief of Operations Jan 16, 2020 100%
W-2 Managing EmployeeChief of Operations Jan 16, 2020 100%
Operational/Managerial ControlChief of Operations Jan 16, 2020 100%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Clinicas del Camino Real Inc-Paseo CamarilloCamarillo, CA, CCN 921181 Federally qualified health center Operational/Managerial Control (100%) Nov 12, 2019
Clinicas del Camino Real Inc la ColoniaOxnard, CA, CCN 921908 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2026

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1134369366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S WELLS RD",
            "address_2": "SUITE 200",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041377",
            "telephone_number": "805-659-1740",
            "fax_number": "805-659-9959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 E VINEYARD AVE",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930361615",
            "telephone_number": "805-436-3444",
            "fax_number": "805-485-4160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAS DEL CAMINO REAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-27",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A",
        "authorized_official_last_name": "BENHARASH",
        "authorized_official_first_name": "FARHAD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "805-659-1740"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550000968",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinicas del Camino Real Inc El Rio",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinicas del Camino Real Inc El Rio",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oxnard, CA

Sources for this page

Verify at the official NPI Registry.