NPIMap

Organization Active NPI

Community Health Centers of Greater Dayton

  • Federally Qualified Health Center (FQHC)
  • Dayton, OH
National Provider Identifier
1124633193
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF GREATER DAYTON
Practice address
3805 Kings Hwy RM C
Dayton, OH 45406-3577
Phone
(937) 528-6830
NPI assigned
Sep 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Gregory Hopkins
Title
Executive Director
Phone
(937) 586-9733

Specialties & licenses 1

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

Addresses

Primary practice location

3805 Kings Hwy RM C
Dayton, OH 45406-3577

Mailing address

1323 W 3Rd St
Dayton, OH 45402-6714
Phone (937) 586-9733

Other names 1

  • Kings Highway Dental Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201201001428 OH Part A Provider - Federally Qualified Health Center (FQHC) 7012094386 Practice locations: Dayton, OH

Federally qualified health center certification: CCN 721868

Legal name
COMMUNITY HEALTH CENTERS OF GREATER DAYTON
Doing business as
KINGS HIGHWAY DENTAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 29, 2020
Last certification
Oct 29, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 28, 2008 in OH
Enrollment address
3805 Kings Hwy
RM C
Dayton, OH 45406-3577

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health Centers of Greater Dayton12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

3805 Kings Hwy
Rm C
Dayton, OH 45406
Phone (937) 256-9808

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
Martin Foos Individual Corporate DirectorBoard Member Dec 1, 2021
Laurie Kemp Individual Corporate DirectorBoard Member Mar 1, 2024
Joseph Beach Individual Corporate DirectorBoard Member Feb 1, 2020
Gregory Hopkins Individual Corporate OfficerChief Executive Officer Mar 1, 2009
Corporate DirectorBoard Member Mar 1, 2009
W-2 Managing EmployeeChief Executive Officer Mar 1, 2009
Operational/Managerial ControlChief Executive Officer Mar 1, 2009
Daniel O'Donnell Individual Corporate DirectorBoard Member May 1, 2024
John L Lyman Individual Corporate DirectorBoard Member Jul 1, 2021
Danielle Bradley Individual Corporate DirectorBoard Member Jul 1, 2023
Dawn William Individual Corporate DirectorBoard Member Mar 1, 2019
Xavier Johnson Individual Corporate DirectorBoard Member Mar 1, 2024
Katherine Joseph Individual Corporate DirectorBoard Member Aug 1, 2023
James L McGuire Individual Corporate DirectorBoard Member Mar 1, 2009
Elizabeth Brewer Individual Corporate DirectorBoard Member May 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.

NPI Registry JSON

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

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1124633193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1323 W 3RD ST",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454026714",
            "telephone_number": "937-586-9733",
            "fax_number": "937-586-9736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 KINGS HWY RM C",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454063577",
            "telephone_number": "937-528-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF GREATER DAYTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-15",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "HOPKINS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "937-586-9733"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kings Highway Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.