NPIMap

Organization Active NPI

Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Santa Monica, CA
National Provider Identifier
1861935652
Registry record updated Sep 11, 2023
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
2401 Lincoln Blvd
Santa Monica, CA 90405-3863
Phone
(310) 392-8636
NPI assigned
Nov 28, 2016
Organization subpart
Yes
Parent organization
VENICE FAMILY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 11, 2023

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 connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

2401 Lincoln Blvd
Santa Monica, CA 90405-3863

Mailing address

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

Other names 1

  • Common Ground Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250204002833 CA Part A Provider - Federally Qualified Health Center (FQHC) 2264339126 Practice locations: Venice, CA

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

Federally qualified health center certification: CCN A01924

Legal name
VENICE FAMILY CLINIC
Doing business as
VENICE FAMILY CLINIC - COMMON GROUND AT JUDY & BERNARD BRISKIN CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 10, 2025
Last certification
Feb 10, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
622 Rose Ave
Venice, CA 90291-2767

National Provider Directory

National Provider Directory
Tax ID family
Venice Family Clinic-Robert34 organizations share this tax ID, including this one
Part of
Venice Family Clinic-Robert

Other organizations with this tax ID 33

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

View all 33

Locations

2401 Lincoln Blvd
Santa Monica, CA 90405
Phone (310) 664-7789

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 DirectorBoard Member, Treasurer 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 Member Jul 1, 2015
Yesenia Gallegos Individual Corporate DirectorBoard Member Jun 1, 2020
John Geresi Individual Corporate DirectorBoard Member Jul 26, 2016
Joy Higa Individual Corporate DirectorBoard Member Aug 1, 2023
Carolina Monge Individual Corporate DirectorBoard Member Oct 1, 2017
Kenrick Bascom Individual Corporate DirectorBoard Member Apr 1, 2017
Susan Fleischman Individual Corporate DirectorBoard Member, Vice Chair Jun 20, 2020
Matthew James Kinney Individual Corporate DirectorBoard Member Aug 1, 2023
Isabela Mihai Individual Corporate OfficerChief Compliance Officer Oct 14, 2024 50%
W-2 Managing EmployeeChief Compliance Officer Oct 14, 2024 50%
Operational/Managerial ControlChief Compliance Officer Oct 14, 2024 50%
Hilda Pena Individual Corporate DirectorBoard Member Apr 1, 2023
Sergio D Bautista Individual Corporate OfficerCfo Sep 15, 2025 50%
W-2 Managing EmployeeCfo Sep 15, 2025 50%
Operational/Managerial ControlCfo Sep 15, 2025 50%
Mark R Gavens Individual Corporate DirectorBoard Member, Board Chair Jun 1, 2020
Michele L Delmonico Individual Corporate DirectorBoard Member 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 OfficerChief Executive Officer Dec 12, 2022 50%
W-2 Managing EmployeeChief Executive Officer 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.

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 102

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

View all 102

NPI Registry JSON

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694390400000",
    "number": "1861935652",
    "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": "2401 LINCOLN BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904053863",
            "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": "2016-11-28",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-11",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Common Ground",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.