NPIMap

Organization Active NPI

Family Health Services of Darke County, Inc.

  • Federally Qualified Health Center (FQHC)
  • Versailles, OH
National Provider Identifier
1013244680
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.
Practice address
10484 Kley Rd
Versailles, OH 45380-9561
Phone
(937) 526-3016
Fax
(937) 526-3809
NPI assigned
Nov 3, 2009
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

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

Authorized official

Name
Jared M Pollick
Title
Executive Director
Phone
(937) 548-9680

Specialties & licenses 1

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

Addresses

Primary practice location

10484 Kley Rd
Versailles, OH 45380-9561

Mailing address

5735 Meeker Rd
Greenville, OH 45331-1180
Phone (937) 548-9680

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040427000749 OH Part B Supplier - Clinic/Group Practice 5698762235 Receives reassigned benefits from 82 practitioners
14 other NPIs on this enrollment
Practice locations: Versailles, OH; Union City, OH; Greenville, OH; New Madison, OH; Arcanum, OH
O20091210000403 OH Part A Provider - Federally Qualified Health Center (FQHC) 5698762235 1 other NPI on this enrollment
Practice locations: Versailles, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013244680. Details of each certification follow.

Federally qualified health center certification: CCN 361959

Legal name
FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 10, 2009
Last certification
Dec 10, 2009
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 16, 1973 in OH
Enrollment address
10484 Kley Rd
Versailles, OH 45380-9561

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Family HLTH SVCS33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Crysta Bloomingdale Individual Corporate Director Jul 30, 2018
Austie M Auker Individual Corporate OfficerCfo Jul 23, 2014
W-2 Managing EmployeeCfo Jul 23, 2014
Alan Ayette Individual Corporate DirectorBoard Member Jul 10, 2023
Michael Robert Maher Individual Corporate DirectorBoard Member Jul 31, 2017
Sonja Etzell Individual Corporate DirectorBoard Member Apr 25, 2016
Joy Greer Individual Corporate DirectorBoard Member Aug 5, 2019
Cassidy Helman Individual Corporate DirectorBoard Member Aug 1, 2022
Kathy S O'Dell Individual Corporate DirectorBoard Member Jun 23, 2014
Jared M Pollick Individual Corporate OfficerCeo May 22, 2020
W-2 Managing EmployeeCeo May 22, 2020
John Warner Individual Corporate DirectorBoard Member Aug 1, 2022
Thomas Treon Individual Corporate DirectorBoard Member Jul 30, 2018
Scott C Clum Individual Corporate DirectorBoard Member Jul 25, 2016

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Comprehensive Health NetworkGreenville, OH, CCN 367444 Home health agency 5% Or Greater Direct Ownership Interest May 19, 2009

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 82

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 82

NPI Registry JSON

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

{
    "created_epoch": "1257206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1013244680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5735 MEEKER RD",
            "city": "GREENVILLE",
            "state": "OH",
            "postal_code": "453311180",
            "telephone_number": "937-548-9680",
            "fax_number": "937-548-2087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10484 KLEY RD",
            "city": "VERSAILLES",
            "state": "OH",
            "postal_code": "453809561",
            "telephone_number": "937-526-3016",
            "fax_number": "937-526-3809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-03",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "POLLICK",
        "authorized_official_first_name": "JARED",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "937-548-9680"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Versailles, OH

Sources for this page

Verify at the official NPI Registry.