NPIMap

Organization Active NPI

Maple City Health Care Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Goshen, IN
National Provider Identifier
1033166095
Registry record updated Dec 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
01035233B Issued in IN
Legal business name
MAPLE CITY HEALTH CARE CENTER, INC.
Practice address
213 Middlebury St
Goshen, IN 46528-2956
Phone
(574) 534-3300
Fax
(574) 534-5412
NPI assigned
May 27, 2006
Last updated
Dec 31, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2020

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

Authorized official

Name
Karen Miller Rush
Title
Director of Finance
Phone
(574) 534-0088

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 01035233B IN Primary
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

213 Middlebury St
Goshen, IN 46528-2956

Mailing address

213 Middlebury St
Goshen, IN 46528-2956
Phone (574) 534-3300

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address maple_city_health_care_center10014192@direct.ochin.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110307000549 IN Part A Provider - Federally Qualified Health Center (FQHC) 2163569401 Practice locations: Goshen, IN
O20110615000145 IN Part B Supplier - Clinic/Group Practice 2163569401 Receives reassigned benefits from 34 practitioners
2 other NPIs on this enrollment
Practice locations: Goshen, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033166095. Details of each certification follow.

Federally qualified health center certification: CCN 151867

Legal name
MAPLE CITY HEALTH CARE CENTER INC
Doing business as
MAPLE CITY HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 7, 2011
Last certification
Mar 7, 2011
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1988 in IN
Enrollment address
213 Middlebury St
Goshen, IN 46528-2956

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: maple_city_health_care_center10014192@direct.ochin.org

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Miguel Millan Individual Corporate Director Feb 24, 2011
Karen M Rush Individual Corporate OfficerCfo Aug 12, 2012
Jenny Martinez Individual Corporate Director Nov 24, 2020
Adam Scharf Individual Corporate Director Nov 24, 2020
Zuri Que Individual W-2 Managing Employee Aug 15, 2022
Kevin Farmwald Individual Corporate Director Feb 24, 2011
Sarah Metzler Individual Corporate Director Nov 25, 2014
Max R Mertz Individual Corporate Director Feb 24, 2011
Denise Mettert Individual Corporate Director Oct 1, 2013

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609372800000",
    "number": "1033166095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 MIDDLEBURY ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465282956",
            "telephone_number": "574-534-3300",
            "fax_number": "574-534-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 MIDDLEBURY ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465282956",
            "telephone_number": "574-534-3300",
            "fax_number": "574-534-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE CITY HEALTH CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MILLER",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "574-534-0088"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IN",
            "license": "01035233B",
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "maple_city_health_care_center10014192@direct.ochin.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "213 Middlebury St",
            "city": "Goshen",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465282956",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Goshen, IN

Sources for this page

Verify at the official NPI Registry.