Family Health Center, Inc.
Organization Active NPI Federally Qualified Health Center (FQHC) · Kalamazoo, MI
NPI 1023560331 · NPPES record last updated Nov 3, 2016
Key facts
- NPI
- 1023560331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FAMILY HEALTH CENTER, INC.
- Practice address
- 505 E Alcott St
Kalamazoo, MI 49001 - Phone
- (269) 349-2641
- Fax
- (269) 349-2898
- NPI assigned
- Nov 3, 2016
- Organization subpart
- No
Authorized official
- Name
- Denise Crawford
- Title
- Executive Director & Ceo
- Phone
- (269) 349-2641
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 9
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 5
Practitioners 66
-
Amanda Harrington, NP-C
-
Irene F Murunga, PA-C
-
Nicholas Leigh Vaden, FNP-C, FNP-BC
-
Karen B. Hopkins, MD
-
Sharifa Amini, DNP- FNP
-
Ebazare Maria Ayewah, M.D.
-
Bayan Bedoor, FNP
-
Amanda Laura Bergan, FNP
-
Alessandra Chatson, DNP
-
Michael Sylvester Clarke, M.D.
-
Skylar Grace Feltner, PA-C
-
Brandie Ann Fridley, PMHNP
-
Kimberlee Therese Gabrielson, DNP, FNP
-
Kimberly Louise Girolami, FNP-C
-
Elisia Jean Grewe, FNP-BC
-
Sarah Hagle, MD
-
Arianna Renee Herron, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Federally qualified health center certification: CCN 231108
- Legal name
- FAMILY HEALTH CENTER, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Mar 25, 2017
- Last certification
- Mar 25, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Other · Non-profit
- Enrollment address
- 505 E Alcott St
Kalamazoo, MI 49001
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Denise R Crawford |
Corporate Officer |
Feb 23, 2009 | |
| Corporate Director |
Feb 23, 2009 | ||
| W-2 Managing Employee |
Feb 23, 2009 | ||
| Efeosa Idemudia |
Corporate Director |
Jan 1, 2019 | |
| Adrian Vazquez |
Corporate Officer |
Jan 1, 2018 | |
| Keela Hemphill |
Corporate Director |
Jan 1, 2022 | |
| Aaron Lane-Davies |
Corporate Director |
Jan 1, 2019 | |
| Tiffany Fuller |
Corporate Director |
Jan 1, 2022 | |
| Patrick Allen Troman |
Corporate Director |
Jan 1, 2019 | |
| Eileen Chiang |
Corporate Officer |
Feb 15, 2010 | |
| Corporate Director |
Feb 15, 2010 | ||
| W-2 Managing Employee | Feb 15, 2010 | ||
| Prabhash Tatineni |
Corporate Director | Jan 1, 2023 | |
| Christine Beverly |
Corporate Director |
Jan 1, 2020 | |
| Roberto Flachier |
Corporate Director |
Jan 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040510000899 | MI | Part B Supplier - Clinic/Group Practice | 1759370216 |
Receives reassigned benefits from 133 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kalamazoo, MI |
| O20170327002600 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 1759370216 | Practice locations: Kalamazoo, MI |
National Provider Directory
- Tax ID family
- Anil Patel MD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
505 E Alcott St
Kalamazoo, MI 49001
Mailing address
117 W Paterson St
Kalamazoo, MI 49007-2557
Phone (269) 349-2641
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All providers in Kalamazoo, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2016. 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.