NPIMap

Organization Active NPI

Florida Atlantic University

Doing business as FAU Community Health Center

  • Federally Qualified Health Center (FQHC)
  • West Palm Beach, FL
National Provider Identifier
1093026619
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FLORIDA ATLANTIC UNIVERSITY
Doing business as
FAU Community Health Center
Practice address
1650 Osceola Drive
West Palm Beach, FL 33409
Phone
(561) 803-8880
Fax
(877) 409-1795
NPI assigned
Jun 29, 2010
Last updated
Jan 5, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FLORIDA ATLANTIC UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Authorized official

Name
Louisa Pontiroli Kelly
Title
Ceo
Phone
(561) 803-8880

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Nurse Practitioner 363L00000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Primary Care Nurse Practitioner 363LP2300X

Addresses

Primary practice location

1650 Osceola Drive
West Palm Beach, FL 33409

Mailing address

1650 Osceola Dr
West Palm Beach, FL 33409-5038
Phone (561) 803-8880

Other practice location 1

720 8th St
West Palm Beach, FL 33401-3606
Phone (561) 803-8880

Other identifiers 7

IdentifierTypeStateIssuer
681903OtherFLFQHC MEDICARE 2021 FOR BOTH 1650 AND 720 LOCATIONS
K3331COtherFLMEDICARE
002Z8OtherFLBCBS
127082701MedicaidFL
C7MZPOtherFLLUCET
127082700MedicaidFL
C11027OtherFLMEDICARE

Other names 1

  • FAU Community Health Center Doing business as

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040511001511 FL Part B Supplier - Clinic/Group Practice 8921097171 Receives reassigned benefits from 30 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Palm Beach, FL; Boca Raton, FL
O20210715001845 FL Part A Provider - Federally Qualified Health Center (FQHC) 8921097171 Practice locations: West Palm Beach, FL
O20240614003196 FL Part A Provider - Federally Qualified Health Center (FQHC) 8921097171 Practice locations: West Palm Beach, FL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1093026619. Details of each certification follow.

Federally qualified health center certification: CCN 681903

Legal name
FLORIDA ATLANTIC UNIVERSITY
Doing business as
COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 15, 2021
Last certification
Jul 15, 2021
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Feb 17, 1993
Enrollment address
1650 Osceola Dr
West Palm Beach, FL 33409-5038

Federally qualified health center certification: CCN C11027

Legal name
FLORIDA ATLANTIC UNIVERSITY
Doing business as
COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 14, 2024
Last certification
Jun 14, 2024
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
720 8TH St
West Palm Beach, FL 33401-3606

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Florida Atlantic University8 organizations share this tax ID, including this one
Part of
Florida Atlantic University

Other organizations with this tax ID 7

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

Locations

777 Glades Rd
Bldg AZ79
Boca Raton, FL 33431
Phone (561) 297-0502

777 Glades Rd
Rm 102
Boca Raton, FL 33431
Phone (561) 297-0164

1650 Osceola Dr
West Palm Beach, FL 33409
Phone (561) 803-8880

Networks

  • HealthSun Health Plans Network

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Cameron Duncan Individual W-2 Managing EmployeeDean May 1, 2025
Julia Gorman Individual Corporate OfficerPractice Manager Jan 1, 2024 100%
Corporate DirectorPractice Manager Jan 1, 2024 100%
W-2 Managing EmployeeAd; Jan 1, 2024 100%
Operational/Managerial ControlPractice Manager Jan 1, 2024 100%
OtherPractice Manager Jan 1, 2024 100%
Corporate OfficerPractice Manager Jun 14, 2024 100%
Corporate DirectorPractice Manager Jun 14, 2024 100%
W-2 Managing EmployeePractice Manager Jun 14, 2024 100%
Florida Atlantic University Organization, West Palm Beach, FL Non-profit Other Jan 1, 2022
Jayson Iroff Individual Corporate OfficerCeo Jul 1, 2024
Corporate DirectorCeo Jul 1, 2024
W-2 Managing EmployeeAd; Jul 1, 2024
Operational/Managerial ControlCeo Jul 1, 2024
Mellissa Harmon Individual Contracted Managing EmployeeSenior Director Contracting and Jun 14, 2024 100%
Corporate OfficerSenior Director Contracting and Jun 14, 2024 100%
Corporate DirectorSenior Director Contracting and Jun 14, 2024 100%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767571200000",
    "number": "1093026619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 OSCEOLA DR",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334095038",
            "telephone_number": "561-803-8880",
            "fax_number": "877-409-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 OSCEOLA DRIVE",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "33409",
            "telephone_number": "561-803-8880",
            "fax_number": "877-409-1795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "720 8th St",
            "address_purpose": "LOCATION",
            "city": "West Palm Beach",
            "state": "FL",
            "postal_code": "334013606",
            "country_code": "US",
            "telephone_number": "561-803-8880",
            "fax_number": "877-409-1795",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FLORIDA ATLANTIC UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA ATLANTIC UNIVERSITY",
        "enumeration_date": "2010-06-29",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A",
        "authorized_official_last_name": "PONTIROLI KELLY",
        "authorized_official_first_name": "LOUISA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-803-8880"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC MEDICARE 2021 FOR BOTH 1650 AND 720 LOCATIONS",
            "identifier": "681903",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K3331C",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "002Z8",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127082701",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LUCET",
            "identifier": "C7MZP",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127082700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C11027",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAU Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FAU Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.