NPIMap

Organization Active NPI

Family Health Services of Erie County

  • Federally Qualified Health Center (FQHC)
  • Milan, OH
National Provider Identifier
1124787122
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH SERVICES OF ERIE COUNTY
Practice address
140 S Main St
Milan, OH 44846-9735
Phone
(419) 502-2800
NPI assigned
Dec 17, 2021
Last updated
Apr 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Authorized official

Name
David Tatro
Title
Ceo
Phone
(419) 502-2822

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU

Addresses

Primary practice location

140 S Main St
Milan, OH 44846-9735

Mailing address

1912 Hayes Ave Ste D
Sandusky, OH 44870-4736
Phone (419) 502-2800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220514000094 OH Part A Provider - Federally Qualified Health Center (FQHC) 0749345296 Practice locations: Milan, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124787122. Details of each certification follow.

Federally qualified health center certification: CCN 721008

Legal name
FAMILY HEALTH SERVICES OF ERIE COUNTY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 22, 2022
Last certification
Apr 22, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 21, 2008 in OH
Enrollment address
140 S Main St
Milan, OH 44846-9735

Other NPIs with the same Medicare PAC ID 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Family Health Services of Erie County21 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 17

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

NameRoleSinceShare
Brent William Burkey Individual Corporate DirectorBoard Member Dec 1, 2019
David Tatro Individual Corporate OfficerChief Executive Officer Jul 8, 2019 100%
W-2 Managing EmployeeChief Executive Officer Jul 8, 2019 100%
Paul Keech Individual Corporate DirectorBoard Member May 1, 2017
James Preston Individual Corporate OfficerBoard Chairman Jan 1, 2018 100%
Corporate DirectorBoard Member Jan 1, 2018 100%
Kathy Pace Individual Corporate DirectorBoard Member Dec 1, 2018
Mattie Sparks Individual Corporate OfficerBoard 2ND Vice President Nov 11, 2019 100%
Corporate DirectorBoard Member Jan 1, 2018 100%
Jack C. Runner Individual Corporate OfficerBoard 1St Vice President Jan 1, 2020 100%
Corporate DirectorBoard Member Jan 1, 2020 100%
Daniel Moncher Individual Corporate DirectorBoard Member May 1, 2017
Jessica Khaledi Individual Corporate DirectorBoard Member Dec 1, 2019
Edward Widman Individual Corporate DirectorBoard Member Oct 1, 2017
Marietta Johnson Individual Corporate OfficerBoard Secretary Oct 1, 2008
Corporate DirectorBoard Member Oct 2, 2008
Pamela Brumbaugh Individual Corporate DirectorBoard Member May 1, 2017
Kaye Burel Individual Corporate DirectorBoard Member Dec 1, 2018
Nancy McKeen Individual Corporate OfficerBoard Treasurer Oct 1, 2008
Corporate DirectorBoard Member Oct 1, 2008
William Zucker Individual Corporate DirectorBoard Member Oct 1, 2008
Charles Poole Individual Corporate DirectorBoard Member Feb 1, 2017
Anthony Pool Individual Corporate DirectorBoard Member Oct 1, 2008

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1639699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1124787122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1912 HAYES AVE STE D",
            "city": "SANDUSKY",
            "state": "OH",
            "postal_code": "448704736",
            "telephone_number": "419-502-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 S MAIN ST",
            "city": "MILAN",
            "state": "OH",
            "postal_code": "448469735",
            "telephone_number": "419-502-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH SERVICES OF ERIE COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-17",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "TATRO",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-502-2822"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milan, OH

Sources for this page

Verify at the official NPI Registry.