NPIMap

Organization Active NPI

Outer Cape Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Wellfleet, MA
National Provider Identifier
1114774445
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
OUTER CAPE HEALTH SERVICES, INC.
Practice address
2700 US 6
Unit 2
Wellfleet, MA 02667
Phone
(508) 905-2434
NPI assigned
May 3, 2024
Organization subpart
Yes
Parent organization
OUTER CAPE HEALTH SERVICES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Authorized official

Name
Damian K Archer, MDNPI 1699921866
Title
Ceo
Phone
(508) 432-1400

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

2700 US 6
Unit 2
Wellfleet, MA 02667

Mailing address

PO Box 598
Harwich Port, MA 02646-0598
Phone (508) 432-1400

Other names 1

  • Outer Cape Health Services - AIM Wellness Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050407000226 MA Part B Supplier - Clinic/Group Practice 4385554971 Receives reassigned benefits from 58 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Harwich Port, MA; Provincetown, MA; Wellfleet, MA
O20240903001570 MA Part A Provider - Federally Qualified Health Center (FQHC) 4385554971 Practice locations: Wellfleet, MA

Federally qualified health center certification: CCN 221013

Legal name
OUTER CAPE HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 3, 2024
Last certification
Sep 3, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 29, 1972 in MA
Enrollment address
2700 State Highway, RT 6
Unit 2
Wellfleet, MA 2667

Other NPIs with the same Medicare PAC ID 3

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
Outer Cape Health Servi5 organizations share this tax ID, including this one
Part of
Outer Cape Health Servi

Other organizations with this tax ID 4

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

Locations

269 Chatham Rd
Harwich, MA 02645
Phone (508) 432-1400

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Patti Stoll Individual Other Jan 1, 2022
Kass Goodwin Individual Other Jan 1, 2023
Marta (Dikke) Hansen Individual Other Jan 1, 2022
Barry McLaughlin Individual Other Jan 1, 2023
Cyndi Williams Individual Other Jan 1, 2023
Barbara a. Penn Individual Other Jan 1, 2022
Larry Ballentine Individual Other Jan 1, 2018
Alton Chun Individual Other Jan 1, 2023
Patti Hartsfield Individual Other Jan 1, 2019
Michael Peterson Individual Other Jan 1, 2019
Peter Epstein Individual Other Jan 1, 2023
Damian Archer Individual Corporate OfficerCeo Jan 1, 2024 100%
Operational/Managerial ControlCeo Jan 1, 2024
Angelica Chilaka Individual Other Jan 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 63

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 63

NPI Registry JSON

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

{
    "created_epoch": "1714694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1114774445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 598",
            "city": "HARWICH PORT",
            "state": "MA",
            "postal_code": "026460598",
            "telephone_number": "508-432-1400",
            "fax_number": "508-487-6298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 US 6",
            "address_2": "UNIT 2",
            "city": "WELLFLEET",
            "state": "MA",
            "postal_code": "02667",
            "telephone_number": "508-905-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTER CAPE HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUTER CAPE HEALTH SERVICES, INC.",
        "enumeration_date": "2024-05-03",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-19",
        "status": "A",
        "authorized_official_last_name": "ARCHER",
        "authorized_official_first_name": "DAMIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "508-432-1400",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Outer Cape Health Services - AIM Wellness Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Outer Cape Health Services - AIM Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wellfleet, MA

Sources for this page

Verify at the official NPI Registry.