Organization Active NPI

Charles Drew Health Center, Inc

Federally Qualified Health Center (FQHC)
Omaha, NE

National Provider Identifier

1003100991

Registry record updated Mar 19, 2021

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Omaha, NE
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name: CHARLES DREW HEALTH CENTER, INC
Practice address: 1111 North 17TH Street
Omaha, NE 68102-4119
Phone: (402) 346-8401
Fax: (402) 453-2061
NPI assigned: Jun 8, 2011
Organization subpart: Yes
Parent organization: CHARLES DREW HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Authorized official

Name: Ms. Tarsha Denise Jackson
Title: Chief Financial Officer
Phone: (402) 457-1215

Specialties & licenses 10

Specialty (taxonomy)	Code	State	Primary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP	101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP	101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP	101YM0800X	NE
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP	101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP	103T00000X
Community Health Clinic/Center	261QC1500X
Community Health Clinic/Center	261QC1500X	NE
Federally Qualified Health Center (FQHC)	261QF0400X	NE	Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP	363A00000X	NE
Community Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP	363LC1500X	NE

Addresses

Primary practice location

1111 North 17TH Street
Omaha, NE 68102-4119

Mailing address

PO Box 30019
Omaha, NE 68103-1119
Phone (402) 451-3553

Other identifiers 1

Identifier	Type	State	Issuer
100260950-00	Medicaid	NE

Other names 1

Charles Drew Health Center, Inc at Siena Francis House Other name

National Provider Directory

Part of: Benson Community Health Center

NPI Registry JSON

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

{
    "created_epoch": "1307491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616112000000",
    "number": "1003100991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30019",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681031119",
            "telephone_number": "402-451-3553",
            "fax_number": "402-457-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 NORTH 17TH STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681024119",
            "telephone_number": "402-346-8401",
            "fax_number": "402-453-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES DREW HEALTH CENTER, INC",
        "enumeration_date": "2011-06-08",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TARSHA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NE",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100260950-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles Drew Health Center, Inc at Siena Francis House",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Charles Drew Health Center, Inc at Siena Francis House",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Charles Drew Health Center, Inc at Siena Francis House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.