NPIMap

Organization Active NPI

Butler County Community Health Consortium, Inc.

  • Federally Qualified Health Center (FQHC)
  • Middletown, OH
National Provider Identifier
1124504378
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.
Practice address
601 N Breiel Blvd Ste B
Middletown, OH 45042
Phone
(513) 454-1111
NPI assigned
Jul 11, 2018
Last updated
Nov 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Authorized official

Name
Ryan G. Randall
Title
Cfo
Phone
(513) 454-1468

Specialties & licenses 1

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

Addresses

Primary practice location

601 N Breiel Blvd Ste B
Middletown, OH 45042

Mailing address

PO Box 837
Hamilton, OH 45012-0837
Phone (515) 454-1468

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040304000056 OH Part B Supplier - Clinic/Group Practice 7810884780 Receives reassigned benefits from 58 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fairfield Township, OH; Trenton, OH; Oxford, OH; Middletown, OH; Hamilton, OH; Dayton, OH; Fairfield, OH
O20181005000784 OH Part A Provider - Federally Qualified Health Center (FQHC) 7810884780 Practice locations: Middletown, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124504378. Details of each certification follow.

Federally qualified health center certification: CCN 361184

Legal name
BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM INC
Doing business as
PRIMARY HEALTH SOLUTIONS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 27, 2018
Last certification
Sep 27, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 15, 2018 in OH
Enrollment address
601 N Breiel Blvd
Ste B
Middletown, OH 45042-3801

Other NPIs with the same Medicare PAC ID 18

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

View all 18

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Josue Colon Individual Corporate DirectorTrustee Jan 1, 2024
Chad Creech Individual Corporate DirectorPresident Jan 1, 2024
Monica Scalf Individual Corporate DirectorTrustee Mar 1, 2026
Gustavo Cocina Individual Corporate DirectorTrustee Mar 1, 2026
William Andrew Groth Individual Corporate DirectorSecretary Mar 1, 2026
Samuel Broyles Individual Corporate DirectorTrustee Mar 1, 2026
Arvind Joshi Individual Corporate DirectorTreasurer Jan 1, 2024
Cynamon Trokhan Individual Corporate DirectorVice President Mar 1, 2026
Sandra Rutledge Individual Corporate DirectorTrustee Mar 1, 2026
Ashley Banks Individual W-2 Managing Employee Jan 1, 2024
Elizabeth Mohr Individual Corporate OfficerCfo Apr 20, 2026
Dennis Kidd Individual Corporate DirectorTrustee Jan 1, 2024
Stephen J Roller Individual Operational/Managerial ControlCeo Owner Jan 1, 2024
Michelle Miller Individual Corporate DirectorTrustee Jan 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.

Practitioners & affiliated clinicians

Practitioners 10

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": "1531267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1124504378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 837",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450120837",
            "telephone_number": "515-454-1468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N BREIEL BLVD STE B",
            "city": "MIDDLETOWN",
            "state": "OH",
            "postal_code": "45042",
            "telephone_number": "513-454-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUTLER COUNTY COMMUNITY HEALTH CONSORTIUM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-11",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "513-454-1468"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, OH

Sources for this page

Verify at the official NPI Registry.