NPIMap

Organization Active NPI

Christ Community Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Memphis, TN
National Provider Identifier
1053572206
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHRIST COMMUNITY HEALTH SERVICES INC
Practice address
969 Frayser Blvd
Memphis, TN 38127-5977
Phone
(901) 260-8400
Fax
(901) 260-8449
NPI assigned
Jun 20, 2008
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Mr. Tracy McDaniel
Title
Ceo
Phone
(901) 842-3160

Specialties & licenses 1

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

Addresses

Primary practice location

969 Frayser Blvd
Memphis, TN 38127-5977

Mailing address

2670 Union Avenue Ext Ste 1000
Memphis, TN 38112-4416
Phone (901) 842-3160

Other identifiers 2

IdentifierTypeStateIssuer
3707256OtherTNMEDICAID GROUP NUMBER
3707256OtherTNMEDICARE GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040528000468 TN Part B Supplier - Clinic/Group Practice 3870402084 Receives reassigned benefits from 100 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Memphis, TN; Jackson, TN
O20050113000309 TN Part A Provider - Federally Qualified Health Center (FQHC) 3870402084 1 other NPI on this enrollment
Practice locations: Memphis, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053572206. Details of each certification follow.

Federally qualified health center certification: CCN 441896

Legal name
CHRIST COMMUNITY HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 11, 2005
Last certification
Feb 11, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2003 in TN
Enrollment address
969 Frayser Blvd
Memphis, TN 38127-5977
Related CCNs
441809

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Christ Community Health Services Inc23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BJCIAD
  • FHIR API: https://fhir4.healow.com/fhir/r4/IJJDAA

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Shantelle N Leatherwood Individual Corporate OfficerCeo Jan 1, 2017
W-2 Managing EmployeeChief Executive Officer Sep 23, 2014
Marlon Wesley Brown Individual Corporate DirectorBoard Member May 1, 2013
Ernest Porter Individual Corporate DirectorBoard Member May 1, 2013
Larry Bishop Lloyd Individual Corporate DirectorBoard Member May 1, 2013
Rebecca Kernan Individual Corporate DirectorBoard Member - Chair May 1, 2013
Leah Hillis Individual Corporate DirectorBoard Member May 1, 2013
Christy Cornell Individual Corporate DirectorBoard Member May 1, 2013
Norma L Hunt Individual Corporate DirectorBoard Member May 1, 2013
Daisy Diaz Individual Corporate DirectorBoard Member May 1, 2013
Kirk Bailey Individual Corporate DirectorBoard Member May 1, 2013
Carolyn G Agapos Individual Corporate DirectorBoard Member May 1, 2013
Marcus E Lewis Individual Corporate DirectorBoard Member May 1, 2013
John Ross Dyer Individual Corporate DirectorBoard Member May 1, 2013
David Guy Individual Corporate OfficerCfo Sep 5, 2019
W-2 Managing EmployeeCfo Sep 5, 2019
Beverly Richardson Individual Corporate DirectorBoard Member May 1, 2013

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": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1053572206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 UNION AVENUE EXT STE 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381124416",
            "telephone_number": "901-842-3160",
            "fax_number": "901-260-8598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 FRAYSER BLVD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381275977",
            "telephone_number": "901-260-8400",
            "fax_number": "901-260-8449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRIST COMMUNITY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-20",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-842-3160",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP NUMBER",
            "identifier": "3707256",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "3707256",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.