NPIMap

Organization Active NPI

Family Health Centers of San Diego Inc

Doing business as Beach Area Family Health Center Annex

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1184982159
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
080000115 Issued in CA
Legal business name
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Doing business as
Beach Area Family Health Center Annex
Practice address
3690 Mission Blvd
San Diego, CA 92109-7368
Phone
(619) 873-6442
Fax
(858) 788-1714
NPI assigned
Apr 27, 2012
Last updated
Feb 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Authorized official

Name
Mr. Ricardo Roman
Title
Cfo
Phone
(619) 515-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 080000115 CA Primary

Addresses

Primary practice location

3690 Mission Blvd
San Diego, CA 92109-7368

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Other names 1

  • Beach Area Family Health Center Annex Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040204000923 CA Part B Supplier - Clinic/Group Practice 3476446378 Receives reassigned benefits from 1,133 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Spring Valley, CA; San Diego, CA; Lemon Grove, CA; El Cajon, CA; Chula Vista, CA
O20130607000543 CA Part A Provider - Federally Qualified Health Center (FQHC) 3476446378 Practice locations: San Diego, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184982159. Details of each certification follow.

Federally qualified health center certification: CCN 751006

Legal name
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Doing business as
BEACH AREA FAMILY HEALTH CTR ANNEX
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 4, 2012
Last certification
Oct 4, 2012
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
May 23, 1973 in CA
Enrollment address
3690 Mission Blvd
San Diego, CA 92109-7368

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Logan Heights Family HL118 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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
Ricardo Roman Individual Corporate DirectorCfo Sep 20, 2010
W-2 Managing EmployeeCfo Sep 20, 2010
Bertha Garcia Individual Corporate Director Nov 12, 1992
Margarita I Carmona Individual Corporate Director Aug 21, 1978
Stephanie Perez Individual Corporate Director Jun 12, 1974
Venus F Thomas Individual Corporate Director Mar 15, 2000
Barbara J Carr Individual Corporate Director Jun 18, 1997
Steven R Olson Individual Corporate Director Aug 13, 2008
Catherine Lester Individual Corporate Director Jan 17, 1990
Claudia Schwartz Individual Corporate Director Oct 17, 1990
Robert Mendes Individual Corporate Director Dec 13, 1995
Jose R de la Garza Individual Corporate Director Jul 29, 1985
Facika Tafara Individual Corporate DirectorMed Dir Oct 28, 2008
W-2 Managing EmployeeMed Dir Mar 3, 2003
Wayne R Anderson Individual Corporate Director Jun 20, 2007
Janice Gilmore-See Individual Corporate Director Nov 18, 1998
Fran Butler-Cohen Individual Corporate OfficerCeo Jan 21, 1986
W-2 Managing EmployeeCeo Jan 21, 1986
Cesar a Solis Individual Corporate Director Jun 21, 2006

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 101

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 101

NPI Registry JSON

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1184982159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300",
            "fax_number": "619-237-1856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3690 MISSION BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921097368",
            "telephone_number": "619-873-6442",
            "fax_number": "858-788-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SAN DIEGO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-27",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "ROMAN",
        "authorized_official_first_name": "RICARDO",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "619-515-2300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "080000115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beach Area Family Health Center Annex",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.