NPIMap

Organization Active NPI

Lincoln Community Health Center Incorporated

Doing business as Lakewood Clinic

  • Federally Qualified Health Center (FQHC)
  • Durham, NC
National Provider Identifier
1114614518
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LINCOLN COMMUNITY HEALTH CENTER INCORPORATED
Doing business as
Lakewood Clinic
Practice address
2020 Chapel Hill Rd Ste 28
Durham, NC 27707-1186
Phone
(919) 956-4000
NPI assigned
Apr 18, 2023
Last updated
Apr 18, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
LINCOLN COMMUNITY HEALTH CENTER INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Authorized official

Name
Hassan Musa Ali
Title
Director of Billing
Phone
(919) 956-4508

Specialties & licenses 1

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

Addresses

Primary practice location

2020 Chapel Hill Rd Ste 28
Durham, NC 27707-1186

Mailing address

1301 Fayetteville St
Durham, NC 27707-2398
Phone (919) 956-4000

Other names 1

  • Lakewood Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231026002117 NC Part A Provider - Federally Qualified Health Center (FQHC) 4587642590 Practice locations: Durham, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114614518. Details of each certification follow.

Federally qualified health center certification: CCN B61014

Legal name
LINCOLN COMMUNITY HEALTH CENTER INCORPORATED
Doing business as
LAKEWOOD CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 26, 2023
Last certification
Oct 26, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 25, 1972 in NC
Enrollment address
2020 Chapel Hill Rd
Ste 28
Durham, NC 27707-1186

Other NPIs with the same Medicare PAC ID 7

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2288260Lincoln Community Health Center at Lakewood2020 Chapel Hill Rd, Ste 28, Durham, NC 27707Provider-performed microscopyAug 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Lincoln Comm Health Ctr8 organizations share this tax ID, including this one
Part of
Lincoln Comm Health Ctr

Other organizations with this tax ID 7

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

Locations

2020 Chapel Hill Rd
Ste 28
Durham, NC 27707
Phone (919) 956-4000

3901 N Roxboro St
#105
Durham, NC 27704
Phone (919) 956-4000

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Ana Velasquez Individual Corporate DirectorVolunteer Board Member Dec 1, 2020
Claudia Gabiota Zuniga Individual Corporate DirectorVolunteer Board Member Jul 1, 2022
Angel Vick-Lewis Individual Corporate DirectorVolunteer Board Member Mar 1, 2020
Kristin E Ito Individual Corporate OfficerCmo Apr 23, 2021
W-2 Managing EmployeeCmo Apr 23, 2021
Maggie Clapp Individual Other Oct 1, 2024
Ronald Williams Individual Corporate DirectorVolunteer Board Member Feb 1, 2019
Elizabeth Stevens Individual Corporate DirectorVolunteer Board Member Nov 1, 2022
William Paul Seagroves Individual Corporate OfficerFco Jun 16, 2014
W-2 Managing EmployeeCfo Jun 16, 2014
Ricky Leon Hart Individual Other Mar 1, 2025
Claretta Foye Individual Corporate OfficerCeo Oct 1, 2021
W-2 Managing EmployeeCeo Oct 1, 2021
Valarie Jarvis Individual Other Oct 1, 2024
Denise Lunsford Individual Other Mar 1, 2025
Wendy Jacobs Individual Corporate DirectorVolunteer Board Member Mar 1, 2021
Dexter Nolley Individual Corporate DirectorVolunteer Board Member Nov 1, 2019
Jose Martinez Beltran Individual Other Oct 1, 2023
Carlotta Jordan Individual Corporate DirectorVolunteer Board Member Oct 1, 2018
Gregory Stephens Individual Other Jul 1, 2024
Frank Whitehead Jr. Individual Other Jul 1, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Lincoln Community Health Center IncorporatedDurham, NC, CCN 341885 Federally qualified health center Operational/Managerial Control May 25, 1972
Holton ClinicDurham, NC, CCN 341950 Federally qualified health center Operational/Managerial Control Jul 1, 2009

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 80

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 80

NPI Registry JSON

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

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1114614518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 FAYETTEVILLE ST",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277072398",
            "telephone_number": "919-956-4000",
            "fax_number": "919-667-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 CHAPEL HILL RD STE 28",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277071186",
            "telephone_number": "919-956-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COMMUNITY HEALTH CENTER INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LINCOLN COMMUNITY HEALTH CENTER INCORPORATED",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-12",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "HASSAN",
        "authorized_official_middle_name": "MUSA",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "919-956-4508"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakewood Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Durham, NC

Sources for this page

Verify at the official NPI Registry.