NPIMap

Organization Active NPI

Clinicas del Camino Real Inc

Doing business as Clinicas del Camino Real, Inc., Oxnard

  • Federally Qualified Health Center (FQHC)
  • Oxnard, CA
National Provider Identifier
1396961884
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
050000128 Issued in CA
Legal business name
CLINICAS DEL CAMINO REAL INC
Doing business as
Clinicas del Camino Real, Inc., Oxnard
Practice address
650 Meta St
Oxnard, CA 93030-7182
Phone
(805) 487-5351
NPI assigned
Apr 17, 2007
Last updated
Jun 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Authorized official

Name
Farhad Benharash
Title
Chief Financial Officer
Phone
(805) 659-1740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 050000128 CA Primary

Addresses

Primary practice location

650 Meta St
Oxnard, CA 93030-7182

Mailing address

200 S Wells Rd
Suite 200
Ventura, CA 93004-1302
Phone (805) 659-1740

Other identifiers 7

IdentifierTypeStateIssuer
014641OtherCAHEALTHY FAMILIES ACCESS D
FHC70103FMedicaidCA
BCP70103FOtherCAEDS CDP EVERY WOMAN COUNT
G90884-01OtherCAHEALTHY FAMILIES DELTA DE
HAP70103FOtherCAHEALTH ACCESS PROGRAM FAM
1251OtherCADELTA DENTAL
ZZZ90946ZOtherCABLUE SHIELD

Other names 1

  • Clinicas del Camino Real, Inc., Oxnard Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031008000002 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173434396 Practice locations: Oxnard, CA
O20040205001238 CA Part B Supplier - Clinic/Group Practice 3173434396 Receives reassigned benefits from 249 practitioners
16 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oxnard, CA; Santa Paula, CA; Simi Valley, CA; Ventura, CA; Ojai, CA; Newbury Park, CA; Moorpark, CA; Fillmore, CA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396961884. Details of each certification follow.

Federally qualified health center certification: CCN 051827

Legal name
CLINICAS DEL CAMINO REAL INC
Doing business as
CLINICAS DEL CAMINO REAL, INC. OXNARD
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1975 in CA
Enrollment address
650 Meta St
Oxnard, CA 93030-7182

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory

Locations

801 Cooper Rd
Oxnard, CA 93030
Phone (805) 330-8100

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 13

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

NameRoleSinceShare
Kirstin Cady Benites Individual Corporate DirectorSecretary Board of Directors Jan 1, 2013 100%
Tim a Hagel Individual Corporate DirectorBoard Member Nov 30, 2020 100%
Charles H Hookstra Individual Corporate DirectorPresident of the Board of Dir. Jan 1, 2013 100%
Candelaria Franco Individual Corporate DirectorBoard Member Jan 23, 2019 100%
Adolfo Murillo Individual Corporate DirectorV.P. of the Board of Directors Jan 1, 2013 100%
Javier M Ochoa Individual Corporate DirectorParliamentarian of Board of Dir Jan 1, 2013 100%
Farhad Benharash Individual Corporate OfficerChief Financial Officer Mar 1, 2022 100%
W-2 Managing EmployeeChief Financial Officer Mar 1, 2022 100%
Operational/Managerial ControlChief Financial Officer Mar 2, 2022 100%
Gagan Pawar Individual Corporate OfficerChief Executive Officer Nov 1, 2021 100%
W-2 Managing EmployeeChief Executive Officer Nov 1, 2021 100%
Operational/Managerial ControlChief Executive Officer Nov 1, 2021 100%
Angel Arreola Individual Corporate DirectorBoard Member Jan 1, 2013 100%
Barbara a Journet Individual Corporate DirectorTreasurer of the Board of Dir. Jan 1, 2013 100%
Robert Cunningham Streeter Individual Corporate OfficerChief Medical Officer Aug 15, 2022 100%
W-2 Managing EmployeeChief Medical Officer Aug 15, 2022 100%
Operational/Managerial ControlChief Medical Officer Aug 15, 2022 100%
Kathryn G Adams Individual Corporate OfficerChief Human Resources Officer Jul 25, 2022 100%
W-2 Managing EmployeeChief Human Resources Officer Jul 25, 2022 100%
Operational/Managerial ControlChief Human Resources Officer Jul 25, 2022 100%
Anna Bell Monroy Individual Corporate OfficerChief of Operations Jan 16, 2020 100%
W-2 Managing EmployeeChief of Operations Jan 16, 2020 100%
Operational/Managerial ControlChief of Operations Jan 16, 2020 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Clinicas del Camino Real Inc-Paseo CamarilloCamarillo, CA, CCN 921181 Federally qualified health center Operational/Managerial Control (100%) Nov 12, 2019
Clinicas del Camino Real Inc la ColoniaOxnard, CA, CCN 921908 Federally qualified health center Operational/Managerial Control (100%) Mar 1, 2026

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1396961884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S WELLS RD",
            "address_2": "SUITE 200",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041302",
            "telephone_number": "805-659-1740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 META ST",
            "city": "OXNARD",
            "state": "CA",
            "postal_code": "930307182",
            "telephone_number": "805-487-5351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAS DEL CAMINO REAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A",
        "authorized_official_last_name": "BENHARASH",
        "authorized_official_first_name": "FARHAD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "805-659-1740"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "050000128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILIES ACCESS D",
            "identifier": "014641",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70103F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS CDP EVERY WOMAN COUNT",
            "identifier": "BCP70103F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILIES DELTA DE",
            "identifier": "G90884-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ACCESS PROGRAM FAM",
            "identifier": "HAP70103F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "1251",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ90946Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinicas del Camino Real, Inc., Oxnard",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinicas del Camino Real, Inc., Oxnard",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oxnard, CA

Sources for this page

Verify at the official NPI Registry.