NPIMap

Organization Active NPI

Camino Health Center

  • Community Health Clinic/Center
  • San Juan Capistrano, CA
National Provider Identifier
1366560393
Registry record updated Jan 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
060000060 Issued in CA
Legal business name
CAMINO HEALTH CENTER
Practice address
30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304
Phone
(949) 240-2030
Fax
(949) 429-7627
NPI assigned
Mar 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2026

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

Authorized official

Name
Jeremy Elkins
Title
Ceo
Phone
(949) 240-2030

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 060000060 CA Primary

Addresses

Primary practice location

30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304

Mailing address

31351 Rancho Viejo Rd Ste 201
San Juan Capistrano, CA 92675-1858
Phone (949) 240-2030

Other identifiers 6

IdentifierTypeStateIssuer
CMM70345HOtherCAMEDICAL
W14149OtherCAMEDICARE PART B
CMM70345HOtherCACALOPTIMA
G91459-01OtherCADENTICAL
CMM70345HOtherCACHDP
EAP70345HOtherCAEAPC

Other names 1

  • Camino 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
O20050106000658 CA Part B Supplier - Clinic/Group Practice 2264480292 Receives reassigned benefits from 7 practitioners
Practice locations: San Juan Capistrano, CA
O20120914000236 CA Part A Provider - Federally Qualified Health Center (FQHC) 2264480292 Practice locations: San Juan Capistrano, CA

Federally qualified health center certification: CCN 551189

Legal name
CAMINO HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 14, 2012
Last certification
Sep 14, 2012
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 20, 2010 in CA
Enrollment address
30300 Camino Capistrano
San Juan Capistrano, CA 92675-1304

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0579553Camino Health Center30300 Camino Capistrano, San Juan Capistrano, CA 92675Provider-performed microscopyMar 21, 2028

National Provider Directory

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
Tammy Alvarez Individual Corporate DirectorBoard Member Nov 9, 2014 100%
Mary L Hamaker Individual Corporate DirectorBoard Member Nov 9, 2010 100%
Jeremy D Elkins Individual Corporate Officer Oct 31, 2022
W-2 Managing EmployeeCeo Oct 31, 2022
Kimsa Duong Individual Corporate DirectorBoard Member Nov 9, 2013 100%
Carol Halesworth Individual Corporate DirectorBoard Member Nov 9, 2014 100%
Phorshia Dillardgatewood Individual Corporate DirectorBoard Member Nov 9, 2010 100%
Melody Vise Individual Corporate DirectorBoard Member Nov 9, 2010 100%
Helen S Gardner Individual Corporate DirectorBoard Member Nov 9, 2010 100%
Kenneth McFarland Individual Corporate DirectorBoard Member Nov 9, 2010 100%
Hank Lobo Individual Corporate DirectorBoard Member Nov 9, 2014 100%
Susan Hoffnagle Individual Corporate DirectorBoard Member Nov 9, 2014 100%

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Camino Health Center Lake ForestLake Forest, CA, CCN 751962 Federally qualified health center Operational/Managerial Control (100%) Jun 30, 1992

Owned or controlled facilities with NPI records 1

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

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 8

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767312000000",
    "number": "1366560393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31351 RANCHO VIEJO RD STE 201",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751858",
            "telephone_number": "949-240-2030",
            "fax_number": "949-429-7627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30300 CAMINO CAPISTRANO",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751304",
            "telephone_number": "949-240-2030",
            "fax_number": "949-429-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMINO HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2026-01-02",
        "certification_date": "2026-01-02",
        "status": "A",
        "authorized_official_last_name": "ELKINS",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-240-2030"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "060000060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "CMM70345H",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "W14149",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALOPTIMA",
            "identifier": "CMM70345H",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTICAL",
            "identifier": "G91459-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHDP",
            "identifier": "CMM70345H",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP70345H",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camino Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Juan Capistrano, CA

Sources for this page

Verify at the official NPI Registry.