NPIMap

Organization Active NPI

Clinicas del Camino Real Inc

Doing business as Clinicas del Camino Real Inc Newbury Park

  • Federally Qualified Health Center (FQHC)
  • Newbury Park, CA
National Provider Identifier
1982820221
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
550000384 Issued in CA
Legal business name
CLINICAS DEL CAMINO REAL INC
Doing business as
Clinicas del Camino Real Inc Newbury Park
Practice address
1000 Newbury Rd
Suite 150
Newbury Park, CA 91320-6435
Phone
(805) 498-3640
Fax
(805) 498-3641
NPI assigned
Apr 17, 2007
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 Oficer
Phone
(805) 659-1740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 550000384 CA Primary

Addresses

Primary practice location

1000 Newbury Rd
Suite 150
Newbury Park, CA 91320-6435

Mailing address

200 S Wells Rd Ste 150
Ventura, CA 93004-1380
Phone (805) 659-2752

Other practice location 1

1000 Newbury Rd Ste 170
Newbury Park, CA 91320-6439
Phone (805) 498-3640

Other practice location 2

1000 Newbury Rd Ste 195
Newbury Park, CA 91320-6440
Phone (805) 498-3640

Other identifiers 5

IdentifierTypeStateIssuer
BCP71164FOtherCAEDS CANCER DETECTION PROG
HAP71164FOtherCAHEALTH ACCESS PROGRAM
ZZZ62823ZOtherCABLUE SHIELD
CMM71164FMedicaidCA
FHC71164FMedicaidCA

Other names 1

  • Clinicas del Camino Real Inc Newbury Park 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
This NPI is an additional NPI on the enrollment
Practice locations: Oxnard, CA; Santa Paula, CA; Simi Valley, CA; Ventura, CA; Ojai, CA; Newbury Park, CA; Moorpark, CA; Fillmore, CA…
O20070918000502 CA Part A Provider - Federally Qualified Health Center (FQHC) 3173434396 Practice locations: Newbury Park, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982820221. Details of each certification follow.

Federally qualified health center certification: CCN 051115

Legal name
CLINICAS DEL CAMINO REAL INC
Doing business as
CLINICAS DEL CAMINO REAL INC, NEWBURY PARK
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 17, 2007
Last certification
Oct 17, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1975 in CA
Enrollment address
1000 Newbury Rd
Stes 150, 170 & 190
Newbury Park, CA 91320-6438

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
Tax ID family
Clinicas del Camino Real Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1000 Newbury Rd
Ste 170
Newbury Park, CA 91320
Phone (805) 498-3640

1000 Newbury Rd
Ste 195
Newbury Park, CA 91320
Phone (805) 498-3640

1424 Madera Rd
Simi Valley, CA 93065
Phone (805) 522-5722

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 - Board of Directors Feb 22, 2012 100%
Tim a Hagel Individual Corporate DirectorBoard Member Nov 30, 2020
Charles H Hookstra Individual Corporate DirectorPresident - Board of Directors Jan 1, 2013 100%
Candelaria Franco Individual Corporate DirectorBoard Member Jan 23, 2019
Adolfo Murillo Individual Corporate DirectorVice President - Board of Direct Jan 1, 2013 100%
Javier M Ochoa Individual Corporate DirectorParliamentarian - Board of Direc Jan 1, 2013 100%
Farhad Benharash Individual Corporate OfficerCfo Mar 1, 2022
W-2 Managing EmployeeCfo Mar 1, 2022
Operational/Managerial ControlCfo Mar 1, 2022
Gagan Pawar Individual Corporate OfficerCeo Nov 1, 2021 100%
W-2 Managing EmployeeCeo Nov 1, 2021 100%
Operational/Managerial ControlCeo Nov 1, 2021 100%
Angel Arreola Individual Corporate DirectorBoard Member Jan 1, 2013 100%
Barbara a Journet Individual Corporate DirectorTreasurer - 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 OfficerChief Human Resources Officer Jul 25, 2022 100%
W-2 Managing EmployeeChief Human Resources Officer Jul 25, 2022 100%
Operational/Managerial ControlChief Human Resources Officer Jul 25, 2022 100%
Anna Bell Monroy Individual Corporate OfficerChief of Operations Jan 16, 2020 100%
Corporate DirectorChief 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 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654560000000",
    "number": "1982820221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S WELLS RD STE 150",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930041380",
            "telephone_number": "805-659-2752",
            "fax_number": "805-659-9959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 NEWBURY RD",
            "address_2": "SUITE 150",
            "city": "NEWBURY PARK",
            "state": "CA",
            "postal_code": "913206435",
            "telephone_number": "805-498-3640",
            "fax_number": "805-498-3641"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Newbury Rd Ste 170",
            "address_purpose": "LOCATION",
            "city": "Newbury Park",
            "state": "CA",
            "postal_code": "913206439",
            "country_code": "US",
            "telephone_number": "805-498-3640",
            "fax_number": "805-498-3641",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Newbury Rd Ste 195",
            "address_purpose": "LOCATION",
            "city": "Newbury Park",
            "state": "CA",
            "postal_code": "913206440",
            "country_code": "US",
            "telephone_number": "805-498-3640",
            "fax_number": "805-498-3641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CLINICAS DEL CAMINO REAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "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 OFICER",
        "authorized_official_telephone_number": "805-659-1740"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "550000384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS CANCER DETECTION PROG",
            "identifier": "BCP71164F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ACCESS PROGRAM",
            "identifier": "HAP71164F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ62823Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CMM71164F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC71164F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinicas del Camino Real Inc Newbury Park",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clinicas del Camino Real Inc Newbury Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newbury Park, CA

Sources for this page

Verify at the official NPI Registry.