NPIMap

Organization Active NPI

Escambia Community Clinics, Inc

  • Federally Qualified Health Center (FQHC)
  • Pensacola, FL
National Provider Identifier
1134854367
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ESCAMBIA COMMUNITY CLINICS, INC
Practice address
1380 N Palafox St
Pensacola, FL 32501-2641
Phone
(850) 436-4630
Fax
(850) 436-2095
NPI assigned
Jul 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Chandra Smiley
Title
Ceo
Phone
(850) 436-4630

Specialties & licenses 1

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

Addresses

Primary practice location

1380 N Palafox St
Pensacola, FL 32501-2641

Mailing address

2315 W Jackson St
Pensacola, FL 32505-7552
Phone (850) 436-4630

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221216001778 FL Part A Provider - Federally Qualified Health Center (FQHC) 9638165806 Practice locations: Pensacola, FL

Federally qualified health center certification: CCN 101193

Legal name
ESCAMBIA COMMUNITY CLINICS INC
Doing business as
COMMUNITY HEALTH NORTHWEST FLORIDA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 16, 2022
Last certification
Dec 16, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in FL
Enrollment address
1380 North Palafox St
Pensacola, FL 32501-2641

Other NPIs with the same Medicare PAC ID 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Alan Pendergrass MD15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Grace McCaffery Individual Corporate DirectorBoard Member Jul 29, 2021
Bob Wilson Individual Corporate DirectorBoard Member Sep 1, 2007
Freddie Cattouse Individual Corporate DirectorBoard Member Sep 1, 2007
Dorothy Foster Individual Corporate DirectorBoard Member Apr 1, 2017
Ann Osiname Individual Corporate DirectorBoard Member Sep 1, 2007
Walter Ritchie Individual Corporate DirectorBoard Member Sep 1, 2007
Chandra Smiley Individual Corporate OfficerExecutive Director Dec 1, 2014
W-2 Managing EmployeeExecutive Director Dec 1, 2014
Operational/Managerial ControlExecutive Director Dec 1, 2014
Jules Kariher Individual Corporate DirectorBoard Member, Vice Chairman Oct 1, 2017
Justin H Labrato Individual Corporate DirectorBoard Member, Treasurer Mar 1, 2014
Joseph Emmanuel Individual Corporate DirectorBoard Member Sep 1, 2007
Brett Aldridge Individual Corporate DirectorBoard Member Jul 1, 2018
John T Porter Individual Corporate DirectorChairman Sep 1, 2007
Sean Seely Individual Corporate DirectorBoard Member Apr 1, 2017

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Health Northwest FloridaPensacola, FL, CCN 681048 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 29, 1992
Community Health Northwest FloridaPensacola, FL, CCN 681849 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 9, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1134854367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2315 W JACKSON ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325057552",
            "telephone_number": "850-436-4630",
            "fax_number": "850-436-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 N PALAFOX ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325012641",
            "telephone_number": "850-436-4630",
            "fax_number": "850-436-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESCAMBIA COMMUNITY CLINICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-21",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "SMILEY",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-436-4630"
    },
    "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 Pensacola, FL

Sources for this page

Verify at the official NPI Registry.