NPIMap

Organization Active NPI

Community Health Care, Inc.

Doing business as Community Health Care, Inc. Outreach Clinic

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
National Provider Identifier
1124008214
Registry record updated Mar 25, 2024
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.
Doing business as
Community Health Care, Inc. Outreach Clinic
Practice address
902 W 4TH St
Davenport, IA 52802-3507
Phone
(563) 336-3000
Fax
(563) 336-3125
NPI assigned
Jan 17, 2006
Last updated
Mar 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2024

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 1

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

Addresses

Primary practice location

902 W 4TH St
Davenport, IA 52802-3507

Mailing address

500 W River Dr
Davenport, IA 52801-1014
Phone (563) 336-3000

Other identifiers 7

IdentifierTypeStateIssuer
0080200MedicaidIA
113373OtherIAUNITED HEALTHCARE
8122859OtherILIL BC/BS
13238OtherIAIA BC/BS GROUP#
=========OtherIABILLING TAX ID# FOR CHC
CP8565OtherIARAILROAD MEDICARE GROUP #
=========MedicaidIL

Other names 1

  • Community Health Care, Inc. Outreach Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040317000776 IA Part B Supplier - Clinic/Group Practice 9830008895 Receives reassigned benefits from 78 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davenport, IA; Muscatine, IA; Clinton, IA
O20240516001019 IA Part A Provider - Federally Qualified Health Center (FQHC) 9830008895 Practice locations: Davenport, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124008214. Details of each certification follow.

Federally qualified health center certification: CCN 161021

Legal name
COMMUNITY HEALTH CARE INC
Doing business as
COMMUNITY HEALTH CARE, INC. OUTREACH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 1, 2024
Last certification
May 1, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 9, 1975 in IA
Enrollment address
902 W 4TH St
Davenport, IA 52802-3507

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 11

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

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
16D2279661Community Health Care, Inc - Outreach902 W 4TH St, Davenport, IA 52802Certificate of waiverApr 4, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Thomas John Bowman Individual Corporate OfficerCeo Aug 13, 2010
W-2 Managing EmployeeCeo Aug 13, 2010
Kevin Hagedorn Individual Corporate OfficerCfo Jun 2, 2014
W-2 Managing EmployeeCfo Jun 2, 2014
Operational/Managerial ControlCfo Jun 2, 2014

Practitioners & affiliated clinicians

Practitioners 8

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": "1137456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711324800000",
    "number": "1124008214",
    "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": "563-336-3044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 W 4TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528023507",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-17",
        "last_updated": "2024-03-25",
        "certification_date": "2024-03-25",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0080200",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "113373",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL BC/BS",
            "identifier": "8122859",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IA BC/BS GROUP#",
            "identifier": "13238",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BILLING TAX ID# FOR CHC",
            "identifier": "=========",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP #",
            "identifier": "CP8565",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "=========",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Care, Inc. Outreach Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.