NPIMap

Organization Active NPI

Family Health Centers of San Diego Inc

Doing business as Oak Park Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1336525906
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
550000465 Issued in CA
Legal business name
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Doing business as
Oak Park Family Health Center
Practice address
5160 Federal Blvd
San Diego, CA 92105-5429
Phone
(619) 515-2454
Fax
(619) 794-2696
NPI assigned
Aug 6, 2015
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 550000465 CA Primary

Addresses

Primary practice location

5160 Federal Blvd
San Diego, CA 92105-5429

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
751838OtherCANORIDIAN MEDICARE

Other names 1

  • OAK PARK FAMILY HEALTH CENTER 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
O20160222002803 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 1336525906. Details of each certification follow.

Federally qualified health center certification: CCN 751838

Legal name
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Doing business as
OAK PARK FAMILY HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
May 23, 1973 in CA
Enrollment address
5160 Federal Blvd
San Diego, CA 92105-5429

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
Family Health Centers of San Diego118 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 13

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 OfficerCfo Sep 20, 2010
Bertha Garcia Individual Corporate DirectorBoard Member Nov 12, 1992
Mary Teresa Sessom Individual Corporate DirectorBoard Member Sep 18, 2013
Daniel Guillen Individual Corporate DirectorBoard Member Jul 24, 2013
Margarita I Carmona Individual Corporate DirectorBoard Member Aug 21, 1978
Venus F Thomas Individual Corporate DirectorBoard Member Mar 15, 2000
Sean Mathews Individual Corporate DirectorBoard Member Jul 24, 2013
Barbara J Carr Individual Corporate DirectorBoard Member Jun 18, 1997
Jose R de la Garza Individual Corporate DirectorBoard Member Jul 29, 1985
Frank Espinoza Individual Corporate DirectorBoard Member Jul 24, 2013
Christopher Gordon Individual W-2 Managing EmployeeMedical Director Sep 17, 2016
Wayne R Anderson Individual Corporate DirectorBoard Member Jun 20, 2007
Fran Butler-Cohen Individual Corporate OfficerPresident & Ceo Jan 21, 1986

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 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1336525906",
    "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": "5160 FEDERAL BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921055429",
            "telephone_number": "619-515-2454",
            "fax_number": "619-794-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SAN DIEGO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-06",
        "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": "550000465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORIDIAN MEDICARE",
            "identifier": "751838",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OAK PARK FAMILY HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.