NPIMap

Organization Active NPI

San Diego Family Care

Doing business as Mid-City Community Clinic

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1306827332
Registry record updated Jul 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAN DIEGO FAMILY CARE
Doing business as
Mid-City Community Clinic
Practice address
4290 Polk Ave
San Diego, CA 92105-1524
Phone
(619) 563-0507
Fax
(619) 563-0015
NPI assigned
Nov 8, 2005
Last updated
Jul 23, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN DIEGO FAMILY CAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 23, 2007

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

Authorized official

Name
Ms. Roberta Lee Feinberg, MS
Title
Chief Executive Officer
Phone
(619) 563-0507

Specialties & licenses 1

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

Addresses

Primary practice location

4290 Polk Ave
San Diego, CA 92105-1524

Mailing address

4290 Polk Ave
San Diego, CA 92105-1524
Phone (619) 563-0507

Other identifiers 6

IdentifierTypeStateIssuer
W815OtherCAOTHER
BCP 11882 FOtherCABCP
HAP 11882 GOtherCASOFP
80406OtherCAHEALTHY FAMILIES
EAP 11672 FOtherCAEXPANDED ACCESS TO PRIMAR
FHC 11882 GOtherCAMEDI-CAL (FQHC)

Other names 1

  • Mid-City Community Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000431 CA Part A Provider - Federally Qualified Health Center (FQHC) 9739090937 Practice locations: San Diego, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306827332. Details of each certification follow.

Federally qualified health center certification: CCN 051875

Legal name
SAN DIEGO FAMILY CARE
Doing business as
MID-CITY COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 1992
Last certification
Jun 4, 1992
Ownership / control type
For profit – partnership
Most recent change of ownership
Dec 12, 2003 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
4290 Polk Ave
San Diego, CA 92105-1524

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Linda Vista Health Care11 organizations share this tax ID, including this one
Part of
Linda Vista Health Care

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Dione Taylor Individual Corporate DirectorBoard Member Oct 1, 2003
Lan Phuong Le Individual Corporate DirectorBoard Member Oct 1, 2012
Helen Smith Individual Corporate DirectorBoard Member Apr 6, 2015
Roger Bailey Individual Corporate DirectorBoard Member Oct 1, 2003
Steven R Tess Individual Corporate DirectorBoard Member Oct 1, 2013
David Leatherberry Individual Corporate DirectorBoard Member Aug 6, 2019
Eliott Ann Estes Individual Corporate DirectorBoard Member Feb 4, 2020
Kathryn S la Poma Individual Corporate DirectorBoard Member Oct 6, 2015
Brenda Talamantes Individual Corporate DirectorBoard Member Jul 10, 2018
Roberta L Feinberg Individual Corporate DirectorCeo Jul 3, 2025
W-2 Managing EmployeeChief Executive Officer Oct 1, 2003
Maria Maderias Individual Corporate DirectorBoard Member Mar 4, 2025

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
San Diego Family CareSan Diego, CA, CCN 751821 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2015

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185148800000",
    "number": "1306827332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4290 POLK AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051524",
            "telephone_number": "619-563-0507",
            "fax_number": "619-563-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4290 POLK AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921051524",
            "telephone_number": "619-563-0507",
            "fax_number": "619-563-0015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO FAMILY CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN DIEGO FAMILY CARE",
        "enumeration_date": "2005-11-08",
        "last_updated": "2007-07-23",
        "status": "A",
        "authorized_official_last_name": "FEINBERG",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "619-563-0507",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER",
            "identifier": "W815",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCP",
            "identifier": "BCP 11882 F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOFP",
            "identifier": "HAP 11882 G",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILIES",
            "identifier": "80406",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXPANDED ACCESS TO PRIMAR",
            "identifier": "EAP 11672 F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL (FQHC)",
            "identifier": "FHC 11882 G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid-City Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.