NPIMap

Organization Active NPI

San Diego Family Care

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
National Provider Identifier
1780665877
Registry record updated Jun 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
080000069 Issued in CA
Legal business name
SAN DIEGO FAMILY CARE
Practice address
6973 Linda Vista Rd
San Diego, CA 92111-6339
Phone
(858) 279-9676
Fax
(858) 279-0377
NPI assigned
Nov 7, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 080000069 CA Primary

Addresses

Primary practice location

6973 Linda Vista Rd
San Diego, CA 92111-6339

Mailing address

6973 Linda Vista Rd
San Diego, CA 92111-6339
Phone (858) 279-9676

Other identifiers 7

IdentifierTypeStateIssuer
80406OtherCAHEALTHY FAMILIES
FHC11672FOtherCACHDP
FHC11672FOtherCAMED CAL FQHC
BCP11672FOtherCABCP
HAP11672FOtherCASOFP
080000069OtherCACLINIC LICENSE
EAP11672FOtherCAEXPANDED ACESS TO PRIMARY

Other names 1

  • Linda Vista Health Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030916000003 CA Part A Provider - Federally Qualified Health Center (FQHC) 9739090937 Practice locations: San Diego, CA

Federally qualified health center certification: CCN 051876

Legal name
SAN DIEGO FAMILY CARE
Doing business as
LINDA VISTA HEALTH CARE CENTER
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 8, 2003 in CA
Enrollment address
6973 Linda Vista Rd
San Diego, CA 92111-6342

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

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

Ownership & related parties

All disclosed owners & managing parties 11

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. Oct 1, 2012
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 EmployeeCeo Oct 1, 2003

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
San Diego Family CareSan Diego, CA, CCN 751821 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2015

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244073600000",
    "number": "1780665877",
    "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": "921116339",
            "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": "6973 LINDA VISTA RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921116339",
            "telephone_number": "858-279-9676",
            "fax_number": "858-279-0377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO FAMILY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-07",
        "last_updated": "2009-06-04",
        "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": "MS"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "080000069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY FAMILIES",
            "identifier": "80406",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHDP",
            "identifier": "FHC11672F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MED CAL FQHC",
            "identifier": "FHC11672F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCP",
            "identifier": "BCP11672F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOFP",
            "identifier": "HAP11672F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC LICENSE",
            "identifier": "080000069",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXPANDED ACESS TO PRIMARY",
            "identifier": "EAP11672F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Linda Vista Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.