NPIMap

Organization Active NPI

Clinicas del Camino Real, Inc

Doing business as Clinicas del Camino Real, Inc., East Simi Valley

  • Federally Qualified Health Center (FQHC)
  • Simi Valley, CA
National Provider Identifier
1609291996
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
550003227 Issued in CA
Legal business name
CLINICAS DEL CAMINO REAL, INC
Doing business as
Clinicas del Camino Real, Inc., East Simi Valley
Practice address
4370 Eve Rd
Simi Valley, CA 93063-2323
Phone
(805) 915-4400
Fax
(805) 915-4401
NPI assigned
Feb 24, 2014
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 550003227 CA Primary

Addresses

Primary practice location

4370 Eve Rd
Simi Valley, CA 93063-2323

Mailing address

200 S Wells Rd
Suite 200
Ventura, CA 93004-1377
Phone (805) 659-1740

Other names 1

  • Clinicas del Camino Real, Inc., East Simi Valley Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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…
O20160210001848 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173434396 Practice locations: Simi Valley, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609291996. Details of each certification follow.

Federally qualified health center certification: CCN 751841

Legal name
CLINICAS DEL CAMINO REAL INC
Doing business as
CLINICAS DEL CAMINO REAL, INC EAST SIMI VALLEY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 23, 2016
Last certification
Mar 23, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1975 in CA
Enrollment address
4370 Eve Rd
Simi Valley, CA 93063-2323

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
Tax ID family
Clinicas del Camino Real Incorporated6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

4370 Eve Rd
Simi Valley, CA 93063
Phone (805) 915-4400

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 of Bod Feb 22, 2012 100%
Tim a Hagel Individual Corporate DirectorBoard Member Nov 30, 2020 100%
Charles H Hookstra Individual Corporate DirectorPresident of Board of Directors Jan 1, 2013 100%
Adolfo Murillo Individual Corporate DirectorVP of Board of Directors Jan 1, 2013 100%
Daniel Gonzalez Individual Corporate DirectorBoard Member Dec 16, 2022 100%
Javier M Ochoa Individual Corporate DirectorParliamentarian of Board of Dire 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 1, 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%
Arminda Lopez Individual Corporate DirectorBoard Member May 22, 2024 100%
Barbara a Journet Individual Corporate DirectorTreasurer of Board of Directors Jan 1, 2013 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%
Alexander Nguyen Individual Corporate DirectorBoard Member Dec 20, 2023

Owners & managing parties with NPI records 1

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

  • Gagan Pawar, MD
    • Family Medicine Physician
    • Ventura, CA
    • NPI 1417110586

    Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

    CMS ownership

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 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1393200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1609291996",
    "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": "930041377",
            "telephone_number": "805-659-1740",
            "fax_number": "805-659-9959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4370 EVE RD",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930632323",
            "telephone_number": "805-915-4400",
            "fax_number": "805-915-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAS DEL CAMINO REAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-24",
        "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": "550003227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinicas del Camino Real, Inc., East Simi Valley",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinicas del Camino Real, Inc., East Simi Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Simi Valley, CA

Sources for this page

Verify at the official NPI Registry.