NPIMap

Organization Active NPI

Community Outreach Medical Center

  • Community Health Clinic/Center
  • Las Vegas, NV
National Provider Identifier
1073721361
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
8907 Issued in NV
Legal business name
COMMUNITY OUTREACH MEDICAL CENTER
Practice address
1090 E Desert Inn Rd Ste 200
Las Vegas, NV 89109-2803
Phone
(702) 657-3873
Fax
(702) 636-0787
NPI assigned
May 18, 2007
Last updated
Mar 29, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Authorized official

Name
Mrs. Kema OgdenNPI 1861895039
Title
Executive Director
Phone
(702) 657-3873

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 8907 NV Primary

Addresses

Primary practice location

1090 E Desert Inn Rd Ste 200
Las Vegas, NV 89109-2803

Mailing address

1090 E Desert Inn Rd Ste 200
Las Vegas, NV 89109-2803
Phone (702) 657-3873

Other identifiers 1

IdentifierTypeStateIssuer
002018167MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141231002003 NV Part B Supplier - Clinic/Group Practice 9830412634 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
Practice locations: Las Vegas, NV

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

1090 E Desert Inn Rd
Ste 200
Las Vegas, NV 89109
Phone (702) 538-9474

1140 Almond Tree Ln
Ste 306
Las Vegas, NV 89104
Phone (702) 538-9474

Ownership & related parties

Subparts reporting this organization as parent 1

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

Practitioners & affiliated clinicians

Practitioners 7

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": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616976000000",
    "number": "1073721361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 E DESERT INN RD STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891092803",
            "telephone_number": "702-657-3873",
            "fax_number": "702-636-0787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 E DESERT INN RD STE 200",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891092803",
            "telephone_number": "702-657-3873",
            "fax_number": "702-636-0787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY OUTREACH MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A",
        "authorized_official_last_name": "OGDEN",
        "authorized_official_first_name": "KEMA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "702-657-3873",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NV",
            "license": "8907",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002018167",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.