NPIMap

Organization Active NPI

Community Health Care Inc

Doing business as Community Health Care Inc - Smart Junior High

  • Federally Qualified Health Center (FQHC)
  • Davenport, IA
National Provider Identifier
1124916911
Registry record updated Oct 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CARE INC
Doing business as
Community Health Care Inc - Smart Junior High
Practice address
1934 W 5TH St
Davenport, IA 52802-1005
Phone
(563) 336-3000
Fax
(563) 336-3125
NPI assigned
Jun 27, 2025
Last updated
Oct 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2025

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

Authorized official

Name
Thomas Bowman
Title
Ceo
Phone
(563) 336-3000

Specialties & licenses 1

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

Addresses

Primary practice location

1934 W 5TH St
Davenport, IA 52802-1005

Mailing address

500 W River Dr
Davenport, IA 52801-1014
Phone (563) 336-3000

Other names 1

  • Community Health Care Inc - Smart Junior High Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040317000776 IA Part B Supplier - Clinic/Group Practice 9830008895 Receives reassigned benefits from 78 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Davenport, IA; Muscatine, IA; Clinton, IA
O20250829000386 IA Part A Provider - Federally Qualified Health Center (FQHC) 9830008895 Practice locations: Davenport, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124916911. Details of each certification follow.

Federally qualified health center certification: CCN 161045

Legal name
COMMUNITY HEALTH CARE INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 12, 2025
Last certification
Aug 12, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1934 W 5TH St
Davenport, IA 52802-1005

Other NPIs with the same Medicare PAC ID 16

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

View all 16

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Care Group of Illinois18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

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
Sarah Moore Individual Corporate DirectorBoard Member Dec 2, 1984
Thomas John Bowman Individual Corporate OfficerCeo Jun 4, 2010
W-2 Managing EmployeeCeo Jun 4, 2010
Operational/Managerial ControlCeo Jun 4, 2010
Kevin Hagedorn Individual Corporate OfficerCfo Jun 2, 2014
W-2 Managing EmployeeCfo Jun 2, 2014
Kristin Humphries Individual Corporate DirectorBoard Member Nov 21, 2023
Lisa Randolph Individual Corporate DirectorBoard Member Nov 5, 2019
Timothy Dahl Individual Corporate DirectorBoard Member Nov 1, 2023
David Joseph Helscher Individual Corporate DirectorBoard Member Jul 2, 2019
Phyllis M Mullett Individual Corporate DirectorBoard Member Nov 5, 2019
Katie Spain Individual Corporate DirectorBoard Member Nov 5, 2019
Laiken Guldenpfenning Individual Corporate Director Feb 25, 2025
Luekinna Hodges Individual Corporate DirectorBoard Member Nov 23, 2023
Daniel Lopez Individual Corporate DirectorBoard Member Nov 23, 2023
Nana Ouro-Agoro Individual Corporate Director Dec 2, 1984
Darryl Dopson Individual Corporate DirectorBoard Member Nov 1, 2018

NPI Registry JSON

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

{
    "created_epoch": "1750982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760918400000",
    "number": "1124916911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W RIVER DR",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528011014",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1934 W 5TH ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528021005",
            "telephone_number": "563-336-3000",
            "fax_number": "563-336-3125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-27",
        "last_updated": "2025-10-20",
        "certification_date": "2025-10-20",
        "status": "A",
        "authorized_official_last_name": "BOWMAN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "563-336-3000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Care Inc - Smart Junior High",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.