NPIMap

Organization Active NPI

Community Health Care

Doing business as Puyallup

  • Federally Qualified Health Center (FQHC)
  • Puyallup, WA
National Provider Identifier
1003515594
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CARE
Doing business as
Puyallup
Practice address
201 W Main
Puyallup, WA 98371-5327
Phone
(253) 722-2161
NPI assigned
Feb 23, 2023
Last updated
Feb 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

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

Authorized official

Name
David Flentge
Title
President & Ceo
Phone
(253) 597-4550

Specialties & licenses 1

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

Addresses

Primary practice location

201 W Main
Puyallup, WA 98371-5327

Mailing address

1148 Broadway Ste 100
Tacoma, WA 98402-3518
Phone (253) 597-4550

Other names 1

  • Puyallup Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241122003474 WA Part A Provider - Federally Qualified Health Center (FQHC) 1850201559 Practice locations: Puyallup, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003515594. Details of each certification follow.

Federally qualified health center certification: CCN 501062

Legal name
COMMUNITY HEALTH CARE
Doing business as
COMMUNITY HEALTH CARE - PUYALLUP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 2024
Last certification
Nov 22, 2024
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jul 1, 2024 in WA
Enrollment address
201 W Main
Puyallup, WA 98371-5327

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory
Tax ID family
Community Healthcare34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Locations

1110 Fryar Ave
Sumner, WA 98390
Phone (253) 863-0406

1213 S 11th St
Tacoma, WA 98405
Phone (206) 597-4163

1301 Tacoma Ave S
Tacoma, WA 98402

1720 E 44th St
Tacoma, WA 98404
Phone (206) 471-4553

1728 E 44th St
Tacoma, WA 98404
Phone (253) 284-2226

3418 McKinley Ave
Tacoma, WA 98404
Phone (253) 404-0737

3611 S D St
Tacoma, WA 98418
Phone (253) 474-4607

3611 S D St
Ste 7
Tacoma, WA 98418
Phone (253) 404-0737

9112 Lakewood Dr SW
Ste 203
Tacoma, WA 98499
Phone (253) 589-7030

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HEDCAA

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Ken Repp Individual Corporate DirectorBoard Member Jan 1, 2021
William Speaker Individual Corporate DirectorBoard Member Jan 1, 2021
David Flentge Individual Corporate OfficerPresident & Ceo Jan 19, 2011 100%
W-2 Managing EmployeePresident & Ceo Jan 19, 2011 100%
Katie Parker Individual Corporate DirectorBoard Chair Jan 1, 2021

Practitioners & affiliated clinicians

Practitioners 119

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 119

NPI Registry JSON

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

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1003515594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1148 BROADWAY STE 100",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023518",
            "telephone_number": "253-597-4550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W MAIN",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983715327",
            "telephone_number": "253-722-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-23",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "FLENTGE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "253-597-4550"
    },
    "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": "Puyallup",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

Verify at the official NPI Registry.