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Organization Active NPI

Clinicas del Camino Real Inc

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

  • Federally Qualified Health Center (FQHC)
  • Ventura, CA
National Provider Identifier
1679631907
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
050000116 Issued in CA
Legal business name
CLINICAS DEL CAMINO REAL INC
Doing business as
Clinicas del Camino Real, Inc., Ventura
Practice address
200 S Wells Rd
Suite 100
Ventura, CA 93004-1302
Phone
(805) 647-6322
Fax
(805) 647-7164
NPI assigned
Dec 6, 2006
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 050000116 CA Primary

Addresses

Primary practice location

200 S Wells Rd
Suite 100
Ventura, CA 93004-1302

Mailing address

200 South Wells Road
Suite 200
Ventura, CA 93004-1302
Phone (805) 659-1740

Other identifiers 8

IdentifierTypeStateIssuer
BCP03908FOtherCAEDS CDP EVERY WOMAN COUNT
HAP03908FOtherCAHEALTH ACCESS PROGRAM FAM
W3731OtherCAMEDICARE NHIC
ZZZ06124ZOtherCABLUE SHIELD
014657OtherCAHEALTHY FAMILIES ACCESS D
FHC03908FMedicaidCA
201251OtherCADELTA DENTAL
G9088402OtherCAHEALTHY FAMILIES DELTA DE

Other names 1

  • Clinicas del Camino Real, Inc., Ventura 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
Practice locations: Oxnard, CA; Santa Paula, CA; Simi Valley, CA; Ventura, CA; Ojai, CA; Newbury Park, CA; Moorpark, CA; Fillmore, CA…
O20091015000703 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173434396 Practice locations: Ventura, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679631907. Details of each certification follow.

Federally qualified health center certification: CCN 051861

Legal name
CLINICAS DEL CAMINO REAL INC
Doing business as
CLINICAS DEL CAMINO REAL , INC VENTURA
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
200 S Wells Rd
Ste 100
Ventura, CA 93004-1378

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

1000 Newbury Rd
Ste 150
Newbury Park, CA 91320
Phone (805) 498-3640

200 S Wells Rd
Ventura, CA 93004
Phone (805) 647-6322

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 the Board of Dir. 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%
Candelaria Franco Individual Corporate DirectorBoard Member Jan 23, 2019 100%
Adolfo Murillo Individual Corporate DirectorVice President of Board of Direc Jan 1, 2013 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 OfficerCeo Apr 1, 2014 100%
W-2 Managing EmployeeCeo Apr 1, 2014 100%
Operational/Managerial ControlCeo Apr 1, 2014 100%
Angel Arreola Individual Corporate DirectorBoard Member Jan 1, 2013 100%
Barbara a Journet Individual Corporate DirectorTreasurer of Board of Directors 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 Officer Jul 25, 2022 100%
W-2 Managing EmployeeChief Human Resorces Officer Jul 25, 2022 100%
Operational/Managerial ControlChief Human Resource 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 266

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 266

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1679631907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SOUTH WELLS ROAD",
            "address_2": "SUITE 200",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041302",
            "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": "200 S WELLS RD",
            "address_2": "SUITE 100",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041302",
            "telephone_number": "805-647-6322",
            "fax_number": "805-647-7164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAS DEL CAMINO REAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "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": "050000116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS CDP EVERY WOMAN COUNT",
            "identifier": "BCP03908F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ACCESS PROGRAM FAM",
            "identifier": "HAP03908F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NHIC",
            "identifier": "W3731",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ06124Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILIES ACCESS D",
            "identifier": "014657",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC03908F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "201251",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILIES DELTA DE",
            "identifier": "G9088402",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinicas del Camino Real, Inc., Ventura",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinicas del Camino Real, Inc., Ventura",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.