NPIMap

Organization Active NPI

Escambia Community Clinics Inc

Doing business as Hwy 90 Pediatrics

  • Federally Qualified Health Center (FQHC)
  • Pace, FL
National Provider Identifier
1033601794
Registry record updated Nov 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ESCAMBIA COMMUNITY CLINICS INC
Doing business as
Hwy 90 Pediatrics
Practice address
4435 Highway 90
Pace, FL 32571
Phone
(850) 436-4630
Fax
(850) 436-2095
NPI assigned
May 30, 2018
Last updated
Nov 30, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
ESCAMBIA COMMUNITY CLINICS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2018

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

Authorized official

Name
Chandra Smiley
Title
Executive Director
Phone
(850) 436-4630

Specialties & licenses 1

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

Addresses

Primary practice location

4435 Highway 90
Pace, FL 32571

Mailing address

2315 W Jackson St
Pensacola, FL 32505-7552
Phone (850) 436-4630

Other names 1

  • Hwy 90 Pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040422001135 FL Part B Supplier - Clinic/Group Practice 9638165806 Receives reassigned benefits from 65 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pensacola, FL; Pace, FL; Milton, FL; Century, FL; Cantonment, FL
O20190108004144 FL Part A Provider - Federally Qualified Health Center (FQHC) 9638165806 Practice locations: Pace, FL
O20191108000121 FL Part B Supplier - Pharmacy 9638165806 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pensacola, FL; Milton, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033601794. Details of each certification follow.

Federally qualified health center certification: CCN 681139

Legal name
ESCAMBIA COMMUNITY CLINICS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2019
Last certification
Jan 9, 2019
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in FL
Enrollment address
4435 Highway 90
Highway 90 Pediatrics
Pace, FL 32571-2066

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Part of
Escambia Community Clin

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Grace McCaffery Individual Corporate DirectorBoard Member Jul 29, 2021
Bob Wilson Individual Corporate DirectorBoard Member Sep 1, 2007
Freddie Cattouse Individual Corporate DirectorBoard Member Sep 1, 2007
Shirley Henderson Individual Corporate DirectorBoard Member Dec 31, 2022
Dorothy Foster Individual Corporate DirectorMember Apr 1, 2017
Ann Osiname Individual Corporate DirectorBoard Member Sep 1, 2007
Chandra Smiley Individual Corporate OfficerExecutive Director Dec 1, 2014
W-2 Managing EmployeeExecutive Director Dec 1, 2014
Operational/Managerial ControlExecutive Director Dec 1, 2014
Jules Kariher Individual Corporate OfficerVice President Jul 1, 2020
Justin H Labrato Individual Corporate OfficerTreasurer Mar 1, 2014
Brett Aldridge Individual Corporate DirectorMember Jul 1, 2018
John T Porter Individual Corporate DirectorChairman Sep 1, 2007
Thomas Owens Individual Corporate DirectorMember Jul 1, 2018
Sean Seely Individual Corporate DirectorMember Apr 1, 2017

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Health Northwest FloridaPensacola, FL, CCN 681048 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 29, 1992
Community Health Northwest FloridaPensacola, FL, CCN 681849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 9, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1527638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543536000000",
    "number": "1033601794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 W JACKSON ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325057552",
            "telephone_number": "850-436-4630",
            "fax_number": "850-436-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4435 HIGHWAY 90",
            "city": "PACE",
            "state": "FL",
            "postal_code": "32571",
            "telephone_number": "850-436-4630",
            "fax_number": "850-436-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESCAMBIA COMMUNITY CLINICS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESCAMBIA COMMUNITY CLINICS INC",
        "enumeration_date": "2018-05-30",
        "last_updated": "2018-11-30",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-436-4630"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hwy 90 Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pace, FL

Sources for this page

Verify at the official NPI Registry.