NPIMap

Organization Active NPI

Detroit Community Health Connection, Inc

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1063790186
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DETROIT COMMUNITY HEALTH CONNECTION, INC
Doing business as
Oscar Paskal Health Center
Practice address
12800 E Warren Ave
Detroit, MI 48215-2061
Phone
(313) 343-2887
Fax
(313) 343-2889
NPI assigned
Jul 22, 2011
Organization subpart
Yes
Parent organization
DETROIT COMMUNITY HEALTH CONNECTION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

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

Authorized official

Name
Mr. Mahipal Rao Kakarala
Title
SRVP/Cfo
Phone
(313) 821-2591

Specialties & licenses 1

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

Addresses

Primary practice location

12800 E Warren Ave
Detroit, MI 48215-2061

Mailing address

12800 E Warren Ave
Detroit, MI 48215-2061
Phone (313) 343-2887

Other identifiers 2

IdentifierTypeStateIssuer
ON30150OtherMIMEDICARE ID
1992196MedicaidMI

Other names 1

  • Oscar Paskal Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326000067 MI Part B Supplier - Clinic/Group Practice 9234021148 Receives reassigned benefits from 23 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI
O20140212000869 MI Part A Provider - Federally Qualified Health Center (FQHC) 9234021148 Practice locations: Detroit, MI

Federally qualified health center certification: CCN 231015

Legal name
DETROIT COMMUNITY HEALTH CONNECTION INC
Doing business as
OSCAR PASKAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 28, 2014
Last certification
Mar 28, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
12800 E Warren Ave
Detroit, MI 48215-2061

Other NPIs with the same Medicare PAC ID 6

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

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
Detroit Community Health Connection

Locations

12800 E Warren Ave
Detroit, MI 48215
Phone (313) 308-1400

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Patrick O Lindsey Individual Corporate DirectorSecretary Oct 27, 2015
Hallistine Stewart Individual Corporate Director Oct 27, 2015
Derek Ware Individual Corporate Director Sep 13, 2024
W-2 Managing EmployeePresident & Ceo Sep 13, 2024
Crystal R Gardner-Martin Individual Corporate Director May 17, 2024
Henry Tokarz Individual Corporate OfficerVice President & Cfo Mar 3, 2025
W-2 Managing EmployeeVice President & Cfo Mar 3, 2025
Henry C Conerway Individual Corporate DirectorVice Chairperson Jul 27, 2021
Linda J Bowie Individual Corporate Director Jul 27, 2021
Mable Jones Individual Corporate Director Feb 27, 2025
Patricia a Wilkerson-Uddyback Individual W-2 Managing EmployeeChief Medical Officer Feb 26, 2024
Gwendolyn J Scales Individual Corporate Director Nov 1, 2009
Thomas E Hardiman Individual Corporate Director Jul 27, 2021
Louise Guyton Individual Corporate DirectorTreasurer Jan 1, 2003
Paul Bridgewater Individual Corporate DirectorBoard Chairperson Sep 1, 2007
Eric B Scott Individual Corporate Director Dec 1, 2024
Vanessa Holsey Individual Corporate Director Sep 1, 2024
Detroit Community Health Connection Inc Organization, Detroit, MI Operational/Managerial Control Aug 11, 2011
Gregory a Jones Individual Corporate Director Oct 27, 2015

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Dr Sophie Womack Health CenterDetroit, MI, CCN 231937 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 1998
Woodward Corridor Family Medical CenterDetroit, MI, CCN 231936 Federally qualified health center Operational/Managerial Control (100%) Apr 18, 1997
Dr Feleta Wilson Health CenterDetroit, MI, CCN 231935 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 1998
Nolan Family Health CenterDetroit, MI, CCN 231934 Federally qualified health center Operational/Managerial Control Feb 11, 2004
Dr Peter Slaughter Health CenterDetroit, MI, CCN 231139 Federally qualified health center Operational/Managerial Control Dec 12, 2018

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436313600000",
    "number": "1063790186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12800 E WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152061",
            "telephone_number": "313-343-2887",
            "fax_number": "313-343-2889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12800 E WARREN AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152061",
            "telephone_number": "313-343-2887",
            "fax_number": "313-343-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT COMMUNITY HEALTH CONNECTION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DETROIT COMMUNITY HEALTH CONNECTION, INC.",
        "enumeration_date": "2011-07-22",
        "last_updated": "2015-07-08",
        "status": "A",
        "authorized_official_last_name": "KAKARALA",
        "authorized_official_first_name": "MAHIPAL",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "SRVP/CFO",
        "authorized_official_telephone_number": "313-821-2591",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "ON30150",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992196",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oscar Paskal Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.