NPIMap

Organization Active NPI

Vista Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Vista, CA
National Provider Identifier
1295822658
Registry record updated Jun 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
080000002 Issued in CA
Legal business name
VISTA COMMUNITY CLINIC
Practice address
1000 Vale Terrace Dr
Vista, CA 92084-5218
Phone
(760) 631-5000
NPI assigned
Oct 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2010

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

Authorized official

Name
Ms. Michele Lambert
Title
Cfo
Phone
(760) 726-0065

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 080000002 CA Primary

Addresses

Primary practice location

1000 Vale Terrace Dr
Vista, CA 92084-5218

Mailing address

1000 Vale Terrace Dr
Vista, CA 92084-5218

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031223000690 CA Part B Supplier - Clinic/Group Practice 0042120156 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Vista, CA
O20100831000708 CA Part A Provider - Federally Qualified Health Center (FQHC) 0042120156 Practice locations: Vista, CA

Federally qualified health center certification: CCN 051939

Legal name
VISTA COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 5, 1994
Last certification
Dec 5, 1994
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Nov 11, 1972 in CA
Enrollment address
1000 Vale Terrace Dr
Vista, CA 92084-5218

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

161 Thunder Dr
Ste 212
Vista, CA 92083
Phone (760) 631-5030

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Antonio Mora Individual Corporate DirectorBoard Member President Jan 1, 2009
Joseph Troya Individual Corporate DirectorBoard Member Vice President Jan 1, 2000
Fernando Sanudo Individual W-2 Managing EmployeeCeo Jan 1, 2013
James Hagar Individual Corporate DirectorBoard Member Jan 1, 1974
Lisa Winberg Individual Corporate DirectorBoard Member Secretary Feb 25, 2021
Mark Phillipi Individual Corporate DirectorBoard Member Mar 31, 2016
Jose Aponte Individual Corporate DirectorBoard Member Sep 1, 2014
Michele Lambert Individual Corporate Officer Jan 1, 2006
W-2 Managing EmployeeCfo Jan 1, 2006
Konane Martinez Individual Corporate DirectorBoard Member Apr 28, 2022
Monica Nava Individual Corporate DirectorBoard Member Jan 1, 2005
Raye Clendening Individual Corporate DirectorBoard Member Interim Secretary Jan 1, 2002
Kwan Lee Individual Corporate DirectorBoard Member Jun 25, 2020
Michael Hire Individual Corporate DirectorBoard Member Treasurer Jan 1, 1999
Angela Perez Individual Corporate DirectorBoard Member Jan 1, 2009

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1295822658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 VALE TERRACE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 VALE TERRACE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920845218",
            "telephone_number": "760-631-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "LAMBERT",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "760-726-0065",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "080000002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.