Frederiksted Health Care, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Christiansted, VI
NPI 1003374380 · NPPES record last updated Mar 6, 2019
Key facts
- NPI
- 1003374380
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FREDERIKSTED HEALTH CARE, INC.
- Practice address
- 4100 Sion Farm Shopp Ctr Ste 5
Christiansted, VI 00820-4433 - Phone
- (340) 772-0260
- NPI assigned
- Mar 6, 2019
- Organization subpart
- No
Authorized official
- Name
- Masserae E Webster
- Title
- Chief Executive Officer
- Phone
- (340) 772-1992
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 5
Practitioners 11
-
Renee N Georges, M.D.
-
Larissa Leffingwell, PA-C
-
Jeanine Thomas, CNM
-
Michael Ingram, MD
-
Jennifer Sherburne, MSN, APRN
-
Melissa Stephany Johnson, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VI
Federally qualified health center certification: CCN 481803
- Legal name
- FREDERIKSTED HEALTH CARE, INC.
- Doing business as
- MID-ISLAND HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 13, 2019
- Last certification
- Jun 13, 2019
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 4100 Sion Farm Commercial Center
Ste 5 & 6
Christiansted, VI 8204383
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Jacquelynn Lorraine Rhymer-George |
Corporate Officer |
May 1, 2019 | 100% |
| W-2 Managing Employee | May 1, 2019 | 100% | |
| Masserae E Sprauve-Webster |
W-2 Managing Employee |
May 1, 2019 | 100% |
| John J Abramson |
Corporate Director |
May 1, 2018 | 100% |
| Loraine Motta |
Corporate Director |
May 1, 2019 | 100% |
| Donna Christensen |
Corporate Director |
May 1, 2019 | 100% |
| Stanley Jones |
Corporate Director |
May 1, 2019 | 100% |
| Ayanna Romney |
Corporate Director |
May 1, 2019 | 100% |
| Roland Benjamin |
Corporate Director |
May 1, 2019 | 100% |
| Kim Daniels |
Corporate Director |
May 1, 2018 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190613002477 | VI | Part a Provider - Federally Qualified Health Center (FQHC) | 7911818778 | Practice locations: Christiansted, VI |
National Provider Directory
- Tax ID family
- Frederiksted Health Care in
Locations
4100 Sion Farm Shopp Ctr
Ste 5
St Croix, VI 00820
Phone (340) 713-7000
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/DEAGDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
4100 Sion Farm Shopp Ctr Ste 5
Christiansted, VI 00820-4433
Mailing address
PO Box 1198
Frederiksted, VI 00841-1198
Phone (340) 772-0260
Other names
- Mid-Island Health Center
Other providers in Christiansted, VI
- Max Fishkin
- Maia Foley
- Foot and Ankle Pain Management
- Foot and Ankle Pain Specialists
- Laura Forbes
- Frederiksted Health Care, Inc.
- Frederiksted Health Care, Inc.
- Lenecia Fregiste
- Rosaria Beatrice Fritz
- Andre A Galiber
All providers in Christiansted, VI · Federally Qualified Health Center (FQHC) in U.S. Virgin Islands
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.