NPIMap

Organization Active NPI

Charter Oak Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartford, CT
National Provider Identifier
1003078734
Registry record updated May 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
00000259 Issued in CT
Legal business name
CHARTER OAK HEALTH CENTER, INC.
Practice address
75 Main St
Hartford, CT 06106-1806
Phone
(860) 550-7500
NPI assigned
Jun 25, 2008
Organization subpart
Yes
Parent organization
CHARTER OAK HEALTH CENTER INC.As reported in NPPES

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Other NPIs with the same Medicare PAC ID 2

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

Practitioners 37

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

View all 37

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081029000515 CT Part A Provider - Federally Qualified Health Center (FQHC) 3870401078 Practice locations: Hartford, CT

Federally qualified health center certification: CCN 071856

Legal name
CHARTER OAK HEALTH CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 19, 2009
Last certification
Jun 19, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 15, 1978 in CT
Enrollment address
75 Main Street
Hartford, CT 61061806

All disclosed owners & managing parties 15

Medicare enrollment files

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

NameRoleSinceShare
Tim Powers Individual Corporate OfficerChief Compliance Officer Oct 1, 2018
Leslie Arroyo Individual Corporate DirectorDirector Jan 1, 2012
Rashad C Collins Individual Corporate OfficerChief Operating Officer Aug 1, 2017
Martin John Individual Corporate DirectorDirector Jan 1, 2012
Claudius McNish Individual Corporate DirectorDirector Jan 1, 2019
Ann Marie Patterson Individual Corporate OfficerChief of Quality Assurance Jan 1, 2012
Valeria Caldwell-Gaines Individual Corporate OfficerDeputy Executive Director / GC Jan 30, 2019
Lolita Young Individual Corporate DirectorDirector Jan 1, 2019
Kathleen Hallahan Individual Corporate OfficerChief Financial Officer Sep 1, 2019
Andrew Bussey Individual Corporate OfficerChief Information Officer Dec 1, 2021
Adrian R Wood Individual Corporate DirectorChairperson, Board of Directors Jan 1, 2016
Anupama Voodarla Individual Corporate OfficerAssociate Chief Medical Officer Oct 1, 2021
Dana Coachman Individual Corporate OfficerVice President of Human Resources Jan 1, 2018
Joel Cruz Individual Corporate DirectorDirector Jan 1, 2016
Nichelle a Mullins Individual Corporate OfficerPresident & Chief Executive Officer Jun 1, 2015 100%
W-2 Managing EmployeePresident & Chief Executive Officer Jun 1, 2015 100%
Operational/Managerial ControlPresident & Chief Executive Officer Jun 1, 2015 100%

National Provider Directory

National Provider Directory
Tax ID family
Charter Oak Health Center6 organizations share this tax ID, including this one
Part of
Charter Oak Health Center

Other organizations with this tax ID 5

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

NPPES NPI Registry

Updated by the provider on May 8, 2026

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

Authorized official

Name
Tim Powers
Title
Chief Compliance Officer
Phone
(860) 550-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 00000259 CT Primary

Addresses

Primary practice location

75 Main St
Hartford, CT 06106-1806

Mailing address

21 Grand St
Hartford, CT 06106-1541
Phone (860) 550-7500

Other identifiers 1

IdentifierTypeStateIssuer
004236007MedicaidCT

Other names 1

  • South Park Inn Other name

NPI Registry JSON

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

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778198400000",
    "number": "1003078734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 GRAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061541",
            "telephone_number": "860-550-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 MAIN ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061806",
            "telephone_number": "860-550-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARTER OAK HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARTER OAK HEALTH CENTER INC.",
        "enumeration_date": "2008-06-25",
        "last_updated": "2026-05-08",
        "certification_date": "2026-05-08",
        "status": "A",
        "authorized_official_last_name": "POWERS",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "860-550-7500"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "00000259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236007",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Park Inn",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.