NPIMap

Organization Active NPI

Community Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Rock Island, IL
National Provider Identifier
1114252012
Registry record updated Apr 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Apr 29, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2013

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

Authorized official

Name
Thomas J Bowman
Title
Ceo
Phone
(563) 336-3000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
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 names 1

  • Community Health Care - Robert Young Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114252012. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Oct 9, 2009 in IL
Enrollment address
2200 3Rd Ave
Rock Island, IL 61201-8840

Other NPIs with the same Medicare PAC ID 16

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

View all 16

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
Tax ID family
Care Group of Illinois18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Sarah Moore Individual Corporate DirectorBoard Member Nov 3, 2020
Thomas John Bowman Individual Corporate OfficerChief Executive Officer Oct 29, 2009
W-2 Managing EmployeeChief Executive Officer Oct 9, 2009
Kevin Hagedorn Individual Corporate OfficerCfo Oct 11, 2023
W-2 Managing EmployeeCfo Oct 11, 2023
Kristin Humphries Individual Corporate DirectorBoard Member Oct 11, 2023
Lisa Randolph Individual Corporate DirectorBoard Member Nov 5, 2019
Timothy Dahl Individual Corporate DirectorBoard Member Nov 1, 2023
David Joseph Helscher Individual Corporate DirectorBoard Member Jul 2, 2019
Phyllis M Mullett Individual Corporate DirectorBoard Member Nov 5, 2019
Katie Spain Individual Corporate DirectorBoard Member Nov 5, 2019
Laiken Guldenpfenning Individual Corporate DirectorBoard Member Feb 25, 2025
Luekinna Hodges Individual Corporate DirectorBoard Member Nov 23, 2023
Daniel Lopez Individual Corporate DirectorBoard Member Nov 23, 2023
Nana Ouro-Agoro Individual Corporate DirectorBoard Member Nov 22, 2023
Darryl Dopson Individual Corporate DirectorBoard Member Nov 1, 2018

Practitioners & affiliated clinicians

Practitioners 9

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": "1255046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367193600000",
    "number": "1114252012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 3RD AVE",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612018840",
            "telephone_number": "309-779-2835",
            "fax_number": "309-779-2819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-09",
        "last_updated": "2013-04-29",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-336-3000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Care - Robert Young Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rock Island, IL

Sources for this page

Verify at the official NPI Registry.