NPIMap

Organization Active NPI

San Diego Family Care

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1457724858
Registry record updated Nov 6, 2015
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
Practice address
7011 Linda Vista Rd
San Diego, CA 92111-6307
Phone
(858) 279-9676
Fax
(858) 279-0377
NPI assigned
Nov 6, 2015
Last updated
Nov 6, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2015

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

Authorized official

Name
Ms. Roberta Lee Feinberg, M.S.
Title
Chief Executive Officer
Phone
(858) 279-9676

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

7011 Linda Vista Rd
San Diego, CA 92111-6307

Mailing address

6973 Linda Vista Rd
San Diego, CA 92111-6342
Phone (858) 279-9676

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160125002634 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 1457724858. Details of each certification follow.

Federally qualified health center certification: CCN 751821

Legal name
SAN DIEGO FAMILY CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 21, 2016
Last certification
Jan 21, 2016
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Oct 8, 2003 in CA
Enrollment address
7011 Linda Vista Rd
San Diego, CA 92111-6307

Other NPIs with the same Medicare PAC ID 2

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
05D2107746San Diego Family Care7011 Linda Vista Rd, San Diego, CA 92111Provider-performed microscopyJan 20, 2028

National Provider Directory

National Provider Directory
Tax ID family
Gilchick Rob11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

4305 University Ave
Ste 150
San Diego, CA 92105
Phone (619) 280-2058

7011 Linda Vista Rd
San Diego, CA 92111
Phone (858) 810-8700

Ownership & related parties

All disclosed owners & managing parties 12

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 DirectorTreasurer, Board of Directors Oct 1, 2003
Lan Phuong Le Individual Corporate DirectorMember, Board of Directors Oct 1, 2012
Helen Smith Individual Corporate DirectorSecretary, Board of Directors Apr 6, 2015
Roger Bailey Individual Corporate DirectorMember, Board of Directors Oct 1, 2003
Steven R Tess Individual Corporate DirectorPresident, Board of Directors Oct 1, 2013
David Leatherberry Individual Corporate DirectorMember, Board of Directors Aug 6, 2019
Eliott Ann Estes Individual Corporate DirectorMember, Board of Directors Feb 4, 2020
Sophia Jimenez Individual Corporate DirectorMember, Board of Directors Dec 1, 2015
Kathryn S la Poma Individual Corporate DirectorVice-President, Board of Directo Oct 6, 2015
Brenda Talamantes Individual Corporate DirectorMember, Board of Directors Jul 10, 2018
Roberta L Feinberg Individual Corporate OfficerChief Executive Officer Jul 16, 1979
W-2 Managing EmployeeChief Executive Officer Jul 16, 1979
San Diego Family Care Organization, San Diego, CA Corporation, Non-profit Operational/Managerial Control Dec 1, 2015 100%

Owners & managing parties with NPI records 2

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

  • San Diego Family Care

    dba Mid-City Community Clinic

    • Federally Qualified Health Center (FQHC)
    • San Diego, CA
    • NPI 1306827332

    Operational/Managerial Control

    CMS ownership
  • San Diego Family Care

    dba Linda Vista Health Care Center

    • Federally Qualified Health Center (FQHC)
    • San Diego, CA
    • NPI 1780665877

    Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 11

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": "1446768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446768000000",
    "number": "1457724858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6973 LINDA VISTA RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921116342",
            "telephone_number": "858-279-9676",
            "fax_number": "858-279-0377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7011 LINDA VISTA RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921116307",
            "telephone_number": "858-279-9676",
            "fax_number": "858-279-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-06",
        "last_updated": "2015-11-06",
        "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": "858-279-9676",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.