NPIMap

Organization Active NPI

Family Health Centers of San Diego, Inc

Doing business as Chula Vista Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
National Provider Identifier
1346480837
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
550000877 Issued in CA
Legal business name
FAMILY HEALTH CENTERS OF SAN DIEGO, INC
Doing business as
Chula Vista Family Health Center
Practice address
251 Landis Ave
Chula Vista, CA 91910-2628
Phone
(619) 515-2500
Fax
(619) 934-9578
NPI assigned
Feb 24, 2009
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 550000877 CA Primary

Addresses

Primary practice location

251 Landis Ave
Chula Vista, CA 91910-2628

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
550000877OtherCALICENSE - STATE OF CALIFORNIA

Other names 1

  • Chula Vista 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
O20091211000510 CA Part A Provider - Federally Qualified Health Center (FQHC) 3476446378 Practice locations: Chula Vista, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346480837. Details of each certification follow.

Federally qualified health center certification: CCN 551005

Legal name
FAMILY HEALTH CENTERS OF SAN DIEGO INC
Doing business as
CHULA VISTA FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 1, 2009
Last certification
Dec 1, 2009
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
May 23, 1973 in CA
Enrollment address
251 Landis Ave
Chula Vista, CA 91910-2628

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

Locations

1111 W Chase Ave
El Cajon, CA 92020
Phone (619) 515-2499

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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
Ricardo Roman Individual Operational/Managerial ControlChief Financial Officer Sep 20, 2010
Bertha Garcia Individual Corporate Director Dec 1, 2008
Mary Teresa Sessom Individual Corporate DirectorBoard Member Sep 18, 2013
Daniel Guillen Individual Corporate DirectorBoard Member Jul 24, 2013
Margarita I Carmona Individual Corporate Director Dec 1, 2008
Stephanie Perez Individual Corporate Director Dec 1, 2008
Venus F Thomas Individual Corporate Director Dec 1, 2008
Sean Mathews Individual Corporate DirectorBoard Member Jul 24, 2013
Barbara J Carr Individual Corporate Director Dec 1, 2008
Jose R de la Garza Individual Corporate Director Dec 1, 2008
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 Director Dec 1, 2008
Fran Butler-Cohen Individual Operational/Managerial ControlPresident & 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 110

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 110

NPI Registry JSON

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

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1346480837",
    "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": "251 LANDIS AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919102628",
            "telephone_number": "619-515-2500",
            "fax_number": "619-934-9578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTERS OF SAN DIEGO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-24",
        "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": "550000877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE - STATE OF CALIFORNIA",
            "identifier": "550000877",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chula Vista Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.