Community Health Care, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Rock Island, IL
NPI 1114252012 · NPPES record last updated Apr 29, 2013
Key facts
- NPI
- 1114252012
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH CARE, INC
- Practice address
- 2200 3Rd Ave
Rock Island, IL 61201-8840 - Phone
- (309) 779-2835
- Fax
- (309) 779-2819
- NPI assigned
- Oct 9, 2009
- Organization subpart
- No
Authorized official
- Name
- Thomas J Bowman
- Title
- Ceo
- Phone
- (563) 336-3000
Other NPIs on the same Medicare enrollment 7
Other NPIs with the same Medicare PAC ID 16
Corporate family (same tax ID) 16
Practitioners 58
-
Melissa L Keith, DNP
-
Craig Osborn, N.P.
-
Amanda Disch, ARNP
-
Audrey Jean Housman, ARNP, FNP-C
-
Chetan Prasad, M.D.
-
Babatunde Emmanuel Aremu, DNP, PMHNP
-
Nichol Ashmore, APRN, FNP-BC
-
Kelli Bartels, DNP, ARNP, NP-C
-
Tara A Furgason, LCPC
-
Alissa A Gordon, APN, DNP
-
Anuradha Ranganath, M.D.
-
Joshua Peter Roorda, FNP-BC
-
Catherine Salsberry, ARNP
-
Lauren N Stein, CNM
-
Madison Claire Adank, FNP-BC
-
Denise M Aden, LISW
-
Seema Antony, ARNP
-
Sarah Bakir, MD
-
Jacklyn Marie Besch, ARNP-FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Federally qualified health center certification: CCN 141136
- Legal name
- COMMUNITY HEALTH CARE INC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 11, 2011
- Last certification
- Jan 11, 2011
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 9, 2009 in IL
- Enrollment address
- 2200 3Rd Ave
Rock Island, IL 61201-8840
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Sarah Moore |
Corporate Director |
Nov 3, 2020 | |
| Thomas John Bowman |
Corporate Officer |
Oct 29, 2009 | |
| W-2 Managing Employee |
Oct 9, 2009 | ||
| Kevin Hagedorn |
Corporate Officer |
Oct 11, 2023 | |
| W-2 Managing Employee |
Oct 11, 2023 | ||
| Kristin Humphries |
Corporate Director |
Oct 11, 2023 | |
| Lisa Randolph |
Corporate Director |
Nov 5, 2019 | |
| Timothy Dahl |
Corporate Director |
Nov 1, 2023 | |
| David Joseph Helscher |
Corporate Director |
Jul 2, 2019 | |
| Phyllis M Mullett |
Corporate Director |
Nov 5, 2019 | |
| Katie Spain |
Corporate Director |
Nov 5, 2019 | |
| Laiken Guldenpfenning |
Corporate Director |
Feb 25, 2025 | |
| Luekinna Hodges |
Corporate Director |
Nov 23, 2023 | |
| Daniel Lopez |
Corporate Director |
Nov 23, 2023 | |
| Nana Ouro-Agoro |
Corporate Director |
Nov 22, 2023 | |
| Darryl Dopson |
Corporate Director |
Nov 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031205000597 | IL | Part B Supplier - Clinic/Group Practice | 9830008895 |
Receives reassigned benefits from 57 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: East Moline, IL; Rock Island, IL; Moline, IL |
| O20110111000364 | IL | Part a Provider - Federally Qualified Health Center (FQHC) | 9830008895 | Practice locations: Rock Island, IL |
National Provider Directory
- Tax ID family
- Communit Y Health Care
Locations
500 W River Dr
Davenport, IA 52801
Phone (563) 327-2035
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes | ||
| Clinical Medical Laboratory | 291U00000X |
Addresses
Primary practice location
2200 3Rd Ave
Rock Island, IL 61201-8840
Mailing address
500 W River Dr
Davenport, IA 52801-1014
Phone (563) 336-3000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114252012 | Medicaid | IL |
Other names
- Community Health Care - Robert Young Center
Other providers in Rock Island, IL
- Brigette Clement
- Ann Colby-Wren
- Cheryl Cole
- Jodie Elizabeth Collins
- Community Chiropractic Clinic SC
- Community Health Care, Inc.
- Community Health Care, Inc.
- Community Health Care, Inc.
- Community Medical Transport LTD
- Richard John Connor
All providers in Rock Island, IL · Federally Qualified Health Center (FQHC) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.