NPIMap

Organization Active NPI

Westside Family Health Center

  • Community Health Clinic/Center
  • Culver City, CA
National Provider Identifier
1831287978
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
960000185 Issued in CA
Legal business name
WESTSIDE FAMILY HEALTH CENTER
Practice address
3861 Sepulveda Blvd
Culver City, CA 90230-4605
Phone
(310) 450-4773
Fax
(310) 450-0873
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Authorized official

Name
Debra A. Farmer
Title
President/Ceo
Phone
(310) 450-4773

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 960000185 CA Primary

Addresses

Primary practice location

3861 Sepulveda Blvd
Culver City, CA 90230-4605

Mailing address

3861 Sepulveda Blvd
Culver City, CA 90230-4605
Phone (310) 450-4773

Other identifiers 1

IdentifierTypeStateIssuer
ZZT11798FMedicaidCA

Other names 1

  • Westside Women's Health Center Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040325000765 CA Part B Supplier - Clinic/Group Practice 5698667749 Receives reassigned benefits from 21 practitioners
Practice locations: Culver City, CA
O20140401001530 CA Part A Provider - Federally Qualified Health Center (FQHC) 5698667749 Practice locations: Culver City, CA

Federally qualified health center certification: CCN 551075

Legal name
WESTSIDE FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 29, 2011
Last certification
Mar 29, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
3861 Sepulveda Blvd
Culver City, CA 90230-4605

National Provider Directory

National Provider Directory

Locations

1711 Ocean Park Blvd
Santa Monica, CA 90405
Phone (310) 450-2191

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Curtis Degenfelder Individual Corporate DirectorTreasurer Apr 1, 2020
Peter Mackler Individual Corporate DirectorMember at Large Apr 1, 2020
Montez Kincy Individual Corporate DirectorMember at Large Apr 1, 2020
Scott Ramer Individual Corporate DirectorChairperson Apr 1, 2020
Carol Ware Individual Corporate DirectorVice Chairperson Apr 1, 2020
Debra Farmer Individual Corporate OfficerPresident/Ceo Aug 28, 1975 100%
W-2 Managing EmployeePresident/Ceo Feb 1, 1999 100%
Veronica Lopez Individual Corporate DirectorMember at Large Apr 1, 2020
Elizabeth Davila Individual Corporate DirectorSecretary Apr 1, 2020

Practitioners & affiliated clinicians

Practitioners 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598313600000",
    "number": "1831287978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3861 SEPULVEDA BLVD",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304605",
            "telephone_number": "310-450-4773",
            "fax_number": "310-450-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3861 SEPULVEDA BLVD",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902304605",
            "telephone_number": "310-450-4773",
            "fax_number": "310-450-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A",
        "authorized_official_last_name": "FARMER",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "310-450-4773"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "960000185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT11798F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westside Women's Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Westside Women's Health Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Culver City, CA

Sources for this page

Verify at the official NPI Registry.