NPIMap

Organization Active NPI

District Clinic Holdings Inc

  • Federally Qualified Health Center (FQHC)
  • Belle Glade, FL
National Provider Identifier
1124373113
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DISTRICT CLINIC HOLDINGS INC
Practice address
39200 Hooker Hwy Ste 101
Belle Glade, FL 33430-5368
Phone
(561) 642-1000
NPI assigned
Jul 17, 2012
Last updated
May 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 4, 2021

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

Authorized official

Name
Darcy Davis
Title
Ceo
Phone
(561) 804-5885

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

39200 Hooker Hwy Ste 101
Belle Glade, FL 33430-5368

Mailing address

1515 N Flagler Dr Ste 101
West Palm Beach, FL 33401-3429
Phone (561) 659-1270

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130524000423 FL Part B Supplier - Clinic/Group Practice 6507955432 Receives reassigned benefits from 5 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riviera Beach, FL
O20150106002388 FL Part A Provider - Federally Qualified Health Center (FQHC) 4486876000 Practice locations: Belle Glade, FL
O20260527002294 FL Part B Supplier - Clinic/Group Practice 4486876000 Receives reassigned benefits from 25 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Palm Beach, FL; Delray Beach, FL; Jupiter, FL; Boca Raton, FL; Belle Glade, FL; Palm Springs, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124373113. Details of each certification follow.

Federally qualified health center certification: CCN 101189

Legal name
DISTRICT CLINIC HOLDINGS INC
Doing business as
CL BRUMBACK PRIMARY CARE CLINIC BELLE GLADE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 6, 2015
Last certification
Jan 6, 2015
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Incorporated
Jul 31, 2012 in FL
Enrollment address
39200 Hooker Highway
Ste 101
Belle Glade, FL 33430-5368

Other NPIs with the same Medicare PAC ID 9

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

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Tax ID family
District Clinic Holdings Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1250 Southwinds Dr
Lantana, FL 33462
Phone (561) 547-6800

5101 W Blue Heron Blvd
Riviera Beach, FL 33418
Phone (561) 542-6111

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Candice R Abbott Individual Corporate OfficerChief Financial Officer Feb 1, 2021
Operational/Managerial ControlChief Financial Officer Feb 1, 2021
District Clinic Holdings Inc Organization, West Palm Beach, FL Non-profit Operational/Managerial Control Aug 1, 2014 100%
Darcy Davis Individual Corporate OfficerCfo Aug 1, 2014

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 9

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

FacilityTypeRoleSince
CL Brumback Primary Care Clinic, LantanaLantana, FL, CCN 101184 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic, DelrayDelray Beach, FL, CCN 101190 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic, West Palm BeachWest Palm Beach, FL, CCN 101194 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinic, Lewis CenterWest Palm Beach, FL, CCN 681017 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2014
CL Brumback Primary Care Clinics, Lake WorthLake Worth, FL, CCN 681059 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 28, 2015
Jul 28, 2015
CL Brumback Primary Care Clinic, Boca RatonBoca Raton, FL, CCN 681087 Federally qualified health center Operational/Managerial Control Apr 10, 2017
District Clinic Holdings IncJupiter, FL, CCN 681088 Federally qualified health center Operational/Managerial Control Mar 6, 2017
CL Brumback Primary Care Clinic Mangonia ParkWest Palm Beach, FL, CCN 681160 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 15, 2019
Oct 15, 2019
Health Care District Community Health CenterPalm Springs, FL, CCN C11056 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 12, 2025

Owned or controlled facilities with NPI records 10

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

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620086400000",
    "number": "1124373113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 N FLAGLER DR STE 101",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334013429",
            "telephone_number": "561-659-1270",
            "fax_number": "561-833-9469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39200 HOOKER HWY STE 101",
            "city": "BELLE GLADE",
            "state": "FL",
            "postal_code": "334305368",
            "telephone_number": "561-642-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTRICT CLINIC HOLDINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "DARCY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-804-5885"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belle Glade, FL

Sources for this page

Verify at the official NPI Registry.