NPIMap

Organization Active NPI

Community Health Care

  • Community Health Clinic/Center
  • Lakewood, WA
National Provider Identifier
1013135235
Registry record updated Jun 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
COMMUNITY HEALTH CARE
Practice address
10510 Gravelly Lake Dr SW
Lakewood, WA 98499-5036
Phone
(253) 589-7030
Fax
(253) 597-4556
NPI assigned
Apr 23, 2007
Last updated
Jun 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2019

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

10510 Gravelly Lake Dr SW
Lakewood, WA 98499-5036

Mailing address

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

Other names 1

  • Lakewood Medical Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110317000293 WA Part A Provider - Federally Qualified Health Center (FQHC) 1850201559 Practice locations: Lakewood, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013135235. Details of each certification follow.

Federally qualified health center certification: CCN 501865

Legal name
COMMUNITY HEALTH CARE
Doing business as
LAKEWOOD CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 1, 2001
Last certification
Nov 1, 2001
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 24, 1987 in WA
Enrollment address
10510 Gravelly Lake SWDR
Lakewood, WA 98499-5036

Other NPIs with the same Medicare PAC ID 12

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2121125Lakewood Clinic10510 Gravelly Lake Dr SW, Lakewood, WA 98499Provider-performed microscopyApr 4, 2028

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

15701 B St E
Tacoma, WA 98445
Phone (253) 544-6534

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Marco Viniegra Individual Corporate OfficerBoard Chair Jan 1, 2022
Ladedria Griffin Stallworth Individual Corporate OfficerBoard Member Jan 1, 2022
David Flentge Individual Corporate Director Apr 6, 2011
W-2 Managing Employee Apr 6, 2011
Boaz Kealy Individual Corporate OfficerBoard Member Jan 1, 2022
Katie Parker Individual Corporate OfficerBoard Member Jan 1, 2022

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559865600000",
    "number": "1013135235",
    "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": "10510 GRAVELLY LAKE DR SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984995036",
            "telephone_number": "253-589-7030",
            "fax_number": "253-597-4556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2019-06-07",
        "status": "A",
        "authorized_official_last_name": "FLENTGE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "253-597-4550"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakewood Medical Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Lakewood Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lakewood, WA

Sources for this page

Verify at the official NPI Registry.