NPIMap

Organization Active NPI

Alliance Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fort Wayne, IN
National Provider Identifier
1053153114
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ALLIANCE HEALTH CENTERS, INC.
Practice address
2700 Lafayette St Ste 50
Fort Wayne, IN 46806-1141
Phone
(260) 266-0780
Fax
(260) 266-0785
NPI assigned
Jun 10, 2024
Last updated
Jun 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Authorized official

Name
Eric Allan Shoemaker
Title
MD
Phone
(260) 423-2675

Specialties & licenses 1

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

Addresses

Primary practice location

2700 Lafayette St Ste 50
Fort Wayne, IN 46806-1141

Mailing address

2700 Lafayette St Ste 110
Fort Wayne, IN 46806-1100
Phone (260) 266-0780

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20201006002848 IN Part B Supplier - Clinic/Group Practice 8022437318 Receives reassigned benefits from 54 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Wayne, IN; Marion, IN; Auburn, IN
O20240711003139 IN Part A Provider - Federally Qualified Health Center (FQHC) 8022437318 Practice locations: Fort Wayne, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053153114. Details of each certification follow.

Federally qualified health center certification: CCN C51045

Legal name
ALLIANCE HEALTH CENTERS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 9, 2024
Last certification
Jul 9, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 30, 2020 in IN
Enrollment address
2700 Lafayette St
Ste 50
Fort Wayne, IN 46806-1141

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory

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
Fernando Zapari Individual Corporate Officer Jun 11, 2024
Bret W Claghorn Individual Corporate Officer Jun 11, 2024
Connie Heflin Individual Corporate Officer Jun 11, 2024
Melissa Grossman Individual Corporate Officer Jun 11, 2024
Philip Giaquinta Individual Corporate Officer Jun 11, 2024
Joseph Jordan Individual Corporate Officer Jun 11, 2024
Harold Odden Individual Corporate Officer Jun 11, 2024
Malik King Individual Corporate Officer Jun 11, 2024
Timothy Price Individual Corporate Officer Jun 11, 2024
Raquel Kline Individual Corporate Officer Jun 11, 2024
Autumn Nichole King Individual Corporate Officer Jun 11, 2024
Corporate Director Jun 11, 2024
W-2 Managing Employee Jun 11, 2024
Phyllis Bragg Individual Corporate Officer Jun 11, 2024
D'Andrae Douse Individual Corporate Officer Jun 11, 2024

Practitioners & affiliated clinicians

Practitioners 4

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": "1717977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1053153114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 LAFAYETTE ST STE 110",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468061100",
            "telephone_number": "260-266-0780",
            "fax_number": "260-266-0785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 LAFAYETTE ST STE 50",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468061141",
            "telephone_number": "260-266-0780",
            "fax_number": "260-266-0785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-10",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "SHOEMAKER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "ALLAN",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "260-423-2675"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.