NPIMap

Organization Active NPI

Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Redondo Beach, CA
National Provider Identifier
1639949191
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VENICE FAMILY CLINIC
Practice address
514 N Prospect Ave Ste 400
Redondo Beach, CA 90277-3040
Phone
(310) 392-8636
NPI assigned
Jan 5, 2024
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
VENICE FAMILY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Dr. Mitesh G Popat, MDNPI 1104057397
Title
Chief Executive Officer
Phone
(310) 664-7901

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

514 N Prospect Ave Ste 400
Redondo Beach, CA 90277-3040

Mailing address

604 Rose Ave
Venice, CA 90291-2767
Phone (310) 392-8636

Other names 1

  • Venice Family Clinic - Allcove Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250703002287 CA Part A Provider - Federally Qualified Health Center (FQHC) 2264339126 Practice locations: Redondo Beach, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639949191. Details of each certification follow.

Federally qualified health center certification: CCN A01961

Legal name
VENICE FAMILY CLINIC
Doing business as
VENICE FAMILY CLINIC- ALLCOVE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 24, 2025
Last certification
Jun 24, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
514 N Prospect Ave
Ste 400
Redondo Beach, CA 90277-3040

Other NPIs with the same Medicare PAC ID 16

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

View all 16

National Provider Directory

National Provider Directory
Tax ID family
Venice Family Clinic34 organizations share this tax ID, including this one
Part of
Venice Family Clinic

Other organizations with this tax ID 33

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

View all 33

Locations

514 N Prospect Ave
Ste 400
Redondo Beach, CA 90277
Phone (310) 374-3426

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Joan Herman Individual Corporate DirectorTreasurer Jun 1, 2019
Joanne Bourne Individual Corporate DirectorBoard Member Jun 1, 2022
Michael St Pierre Individual Corporate DirectorBoard Member Jul 1, 2016
Taryn a Keane Individual Corporate DirectorBoard Member Jul 1, 2019
Jeffrey E Sinaiko Individual Corporate DirectorBoard Chair Jul 1, 2015
Yesenia Gallegos Individual Corporate DirectorBoard Member Jun 1, 2020
John Geresi Individual Corporate DirectorChair, Resource Development Jul 26, 2016
Joy Higa Individual Corporate DirectorBoard Member Aug 1, 2023
Jennifer Campos Individual Corporate DirectorBoard Member Jun 15, 2024
Carolina Monge Individual Corporate Director Oct 1, 2017
Kenrick Bascom Individual Corporate DirectorBoard Member Apr 1, 2017
Susan Fleischman Individual Corporate DirectorVice Chair Jun 20, 2020
Matthew James Kinney Individual Corporate DirectorBoard Member Aug 1, 2023
Hilda Pena Individual Corporate DirectorBoard Member Apr 1, 2023
Andrea Blackbird Individual Corporate OfficerCfo Mar 3, 2014 50%
W-2 Managing EmployeeCfo Mar 3, 2014 50%
Operational/Managerial ControlCfo Mar 3, 2014 50%
Mark R Gavens Individual Corporate DirectorBoard Chair Jun 1, 2020
Michele L Delmonico Individual Corporate Director Jun 1, 2020
Olga Carrasco Individual Corporate DirectorBoard Member Jul 1, 2016
Mayer B Davidson Individual Corporate DirectorBoard Member Jul 1, 2015
Mitesh Popat Individual Corporate OfficerCeo Dec 12, 2022 50%
W-2 Managing EmployeeCeo Dec 12, 2022 50%
Operational/Managerial ControlCeo Dec 12, 2022 50%
Diana Carsola Individual Corporate DirectorBoard Member Jul 1, 2016
Sharon L Gelfand Individual Corporate DirectorBoard Member Jun 1, 2020

Owners & managing parties with NPI records 1

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

  • Mitesh G Popat, MD
    • Family Medicine Physician
    • Venice, CA
    • NPI 1104057397

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

    CMS ownership

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Venice Family Clinic-Bills Clinic at Safe Place for YouthVenice, CA, CCN 751948 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 27, 1974
Venice Family Clinic-Santa Monica High SchoolSanta Monica, CA, CCN 751960 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Mar 27, 1974
Venice Family ClinicCarson, CA, CCN 751055 Federally qualified health center 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Oct 1, 2021
Oct 1, 2021
Venice Family Clinic - Sandy Segal Youth Health CenterCulver City, CA, CCN A01923 Federally qualified health center Operational/Managerial Control Feb 1, 2017

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1704412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1639949191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 ROSE AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912767",
            "telephone_number": "310-392-8636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 N PROSPECT AVE STE 400",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773040",
            "telephone_number": "310-392-8636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VENICE FAMILY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VENICE FAMILY CLINIC",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "POPAT",
        "authorized_official_first_name": "MITESH",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "310-664-7901",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Venice Family Clinic - Allcove",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Redondo Beach, CA

Sources for this page

Verify at the official NPI Registry.