NPIMap

Organization Active NPI

Florida Community Health Centers Inc

  • Family Medicine Physician
  • Clewiston, FL
National Provider Identifier
1124078571
Registry record updated Jun 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
FLORIDA COMMUNITY HEALTH CENTERS INC
Practice address
315 S W C Owen Ave
Clewiston, FL 33440-3637
Phone
(863) 983-7813
Fax
(863) 983-9604
NPI assigned
May 10, 2006
Last updated
Jun 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2016

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

Authorized official

Name
Dr. Michael F Gervasi, D.O.NPI 1043241375
Title
President & Ceo
Phone
(561) 844-9443

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

315 S W C Owen Ave
Clewiston, FL 33440-3637

Mailing address

5827 Corporate Way
West Palm Beach, FL 33407-2000
Phone (561) 844-9443

Other names 1

  • Clewiston Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040515000037 FL Part B Supplier - Clinic/Group Practice 9931017126 Receives reassigned benefits from 95 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Okeechobee, FL; West Palm Beach, FL; Stuart, FL; Port St. Lucie, FL; Port St Lucie, FL; Pahokee, FL; Moore Haven, FL; Indiantown, FL…
O20100908001102 FL Part A Provider - Federally Qualified Health Center (FQHC) 9931017126 Practice locations: Clewiston, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124078571. Details of each certification follow.

Federally qualified health center certification: CCN 101854

Legal name
FLORIDA COMMUNITY HEALTH CENTERS INC
Doing business as
CLEWISTON CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 14, 1976 in FL
Enrollment address
315 S W C Owen Ave
Clewiston, FL 33440-3637

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Florida Comm HLTH CT in21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Eutris Delancy Individual Corporate DirectorBoard Member Feb 1, 2017
Brian Rucks Individual Corporate DirectorBoard Treasurer Jul 19, 2010
Margaret V Russell Individual Corporate OfficerChief Financial Officer Jul 21, 2018
Maria Valdez Individual Corporate DirectorBoard Member Jul 1, 2023
Kenneth Mills Individual Corporate DirectorBoard Chair Feb 1, 2012
Wilhelmina Lewis Individual Corporate OfficerPresident and Ceo Jan 2, 2011
Corporate DirectorPresident and Ceo Jan 2, 2011
W-2 Managing EmployeePresident and Ceo Jan 2, 2011
Karen Cotton Individual Corporate Director Jul 19, 2010
Donald Hart Individual Corporate DirectorBoard Member Jul 1, 2022
Marcia Ann Marie Franklyn Individual Corporate DirectorBoard Member Jan 12, 2026
Linda Tapia Individual Corporate DirectorBoard Vice-Chair Feb 1, 2020
Annita McKnight Individual Corporate DirectorBoard Member Jan 12, 2026
Janet Taylor Individual Corporate Director Jul 19, 2010

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 11

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

FacilityTypeRoleSince
Pahokee CHCPahokee, FL, CCN 101809 Federally qualified health center Operational/Managerial Control Apr 1, 2018
Indiantown CenterIndiantown, FL, CCN 101858 Federally qualified health center Operational/Managerial Control Apr 1, 2018
Moore Haven CenterMoore Haven, FL, CCN 101100 Federally qualified health center Operational/Managerial Control Apr 1, 2018
Stuart CenterStuart, FL, CCN 101113 Federally qualified health center Operational/Managerial Control Apr 1, 2018
Grace Women's Health CenterFort Pierce, FL, CCN 101139 Federally qualified health center Operational/Managerial Control Apr 1, 2018
Darwin Square CenterPort St Lucie, FL, CCN 681038 Federally qualified health center Operational/Managerial Control Dec 29, 2015
Florida Community Health Centers IncFort Pierce, FL, CCN 681936 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2021
Florida Community Health Centers IncWest Palm Beach, FL, CCN 681951 Federally qualified health center Operational/Managerial Control Aug 1, 2021
Florida Community Health Centers IncPort St Lucie, FL, CCN 681955 Federally qualified health center Operational/Managerial Control Aug 1, 2021
Florida Community Health Centers IncBelle Glade, FL, CCN 101028 Federally qualified health center Operational/Managerial Control Sep 16, 2022
Florida Community Health Centers IncPort St Lucie, FL, CCN C11035 Federally qualified health center Operational/Managerial Control Jul 29, 2024

Owned or controlled facilities with NPI records 11

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

Practitioners & affiliated clinicians

Practitioners 88

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 88

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466121600000",
    "number": "1124078571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5827 CORPORATE WAY",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334072000",
            "telephone_number": "561-844-9443",
            "fax_number": "561-844-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 S W C OWEN AVE",
            "city": "CLEWISTON",
            "state": "FL",
            "postal_code": "334403637",
            "telephone_number": "863-983-7813",
            "fax_number": "863-983-9604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2016-06-17",
        "status": "A",
        "authorized_official_last_name": "GERVASI",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "561-844-9443",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clewiston Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clewiston, FL

Sources for this page

Verify at the official NPI Registry.