NPIMap

Organization Active NPI

Inner City Health Center

  • Federally Qualified Health Center (FQHC)
  • Wheat Ridge, CO
National Provider Identifier
1013491208
Registry record updated Jan 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INNER CITY HEALTH CENTER
Practice address
6301 W 38TH Ave
Wheat Ridge, CO 80033-5057
Phone
(303) 940-9118
NPI assigned
Sep 24, 2018
Organization subpart
Yes
Parent organization
INNER CITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2024

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

Authorized official

Name
Andrea Cortez
Title
Coo
Phone
(720) 833-5099

Specialties & licenses 1

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

Addresses

Primary practice location

6301 W 38TH Ave
Wheat Ridge, CO 80033-5057

Mailing address

3800 N York St
Denver, CO 80205-3540
Phone (303) 296-1767

Other identifiers 1

IdentifierTypeStateIssuer
4017372MedicaidCO

Other names 2

  • Inner City Health Center At Wheatridge Other name
  • Wheat Ridge At Inner City Health Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000093 CO Part B Supplier - Clinic/Group Practice 4688562697 Receives reassigned benefits from 29 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Denver, CO; Wheat Ridge, CO
O20200211000515 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688562697 Practice locations: Wheat Ridge, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013491208. Details of each certification follow.

Federally qualified health center certification: CCN 061010

Legal name
INNER CITY HEALTH CENTER
Doing business as
INNER CITY HEALTH AT WHEAT RIDGE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 2020
Last certification
Feb 6, 2020
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Oct 1, 2019 in CO
Enrollment address
6301 W 38TH Ave
Wheat Ridge, CO 80033-5057

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Inner City Health Cente

Networks

  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Andrew Shahidi Individual Corporate OfficerChief Financial Officer Dec 11, 2017
W-2 Managing Employee Dec 11, 2017
Charles Gilford Individual Corporate OfficerChief Executive Officer May 1, 2024
Corporate Director May 1, 2024
W-2 Managing EmployeeAd; May 1, 2024
Operational/Managerial Control May 1, 2024
Andrea Cortez Individual Corporate OfficerChief Operating Officer Oct 1, 2021
Operational/Managerial ControlChief Operating Officer Oct 1, 2021

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1537747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705881600000",
    "number": "1013491208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 N YORK ST",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802053540",
            "telephone_number": "303-296-1767",
            "fax_number": "303-296-3484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 W 38TH AVE",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800335057",
            "telephone_number": "303-940-9118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNER CITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INNER CITY HEALTH CENTER",
        "enumeration_date": "2018-09-24",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "CORTEZ",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "720-833-5099"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4017372",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Inner City Health Center At Wheatridge",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Wheat Ridge At Inner City Health Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Wheat Ridge At Inner City Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wheat Ridge, CO

Sources for this page

Verify at the official NPI Registry.