NPIMap

Organization Active NPI

Suncoast Community Health Centers Inc

Doing business as Tom Lee Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Dover, FL
National Provider Identifier
1144230640
Registry record updated Mar 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SUNCOAST COMMUNITY HEALTH CENTERS INC
Doing business as
Tom Lee Community Health Center
Practice address
14254 Martin Luther King Blvd
Dover, FL 33527-4414
Phone
(813) 349-7700
Fax
(813) 349-7761
NPI assigned
Aug 8, 2006
Last updated
Mar 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2016

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

Authorized official

Name
Robert Rodriguez
Title
Chief Financial Officer
Phone
(813) 349-7563

Specialties & licenses 1

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

Addresses

Primary practice location

14254 Martin Luther King Blvd
Dover, FL 33527-4414

Mailing address

14254 Martin Luther King Blvd
Dover, FL 33527-4414
Phone (813) 349-7700

Other identifiers 1

IdentifierTypeStateIssuer
029523001MedicaidFL

Other names 1

  • Tom Lee Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031210000518 FL Part A Provider - Federally Qualified Health Center (FQHC) 3870402548 1 other NPI on this enrollment
Practice locations: Dover, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144230640. Details of each certification follow.

Federally qualified health center certification: CCN 101917

Legal name
SUNCOAST COMMUNITY HEALTH CENTERS INC
Doing business as
TOM LEE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 12, 1996
Last certification
Sep 12, 1996
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1977 in FL
Enrollment address
14254 Dr Martin Luther King Jr Blvd
Dover, FL 33527-4414

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0681451Tom Lee Community Health Center14254 Dr MLK Jr Dr (Sr 574), Dover, FL 33527Certificate of waiverOct 10, 2027

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
Roberto Morales Individual Corporate OfficerCoo Jan 1, 2022
W-2 Managing EmployeeCoo Jan 1, 2022
Operational/Managerial ControlCoo Jan 1, 2022
Gwendolyn Smalley Individual Corporate DirectorBoard Member Sep 8, 2010
Bradley Herremans Individual Corporate OfficerCeo Sep 8, 2010
W-2 Managing EmployeeAd; Sep 8, 2010
Operational/Managerial ControlCeo Sep 8, 2010
Nancy Hewlett Individual Corporate DirectorBoard Member Jan 1, 2022
Brian Shaub Individual Corporate OfficerChief Medical Director Jan 1, 2022
W-2 Managing EmployeeMD; Jan 1, 2022
Operational/Managerial ControlChief Medical Director Jan 1, 2022
Carlos Garcia Individual Corporate DirectorVice Chair Sep 8, 2010
Susan Peltz Individual Corporate OfficerCfo Jan 3, 2025
W-2 Managing EmployeeCfo Jan 3, 2025
Operational/Managerial ControlCfo Jan 1, 2025
Elbert Odor Individual Corporate DirectorBoard Member Jan 1, 2022
Nelson Ramos Individual Corporate DirectorBoard Member Sep 8, 2010
Maria Consuela Huber Individual Corporate DirectorBoard Treasurer Jan 1, 2022
Aura M Cisneros Individual Corporate OfficerChief Dental Officer Jan 1, 2022
W-2 Managing EmployeeChief Dental Officer Jan 1, 2022
Operational/Managerial ControlChief Dental Officer Jan 1, 2022
Krystal Lockhart Individual Corporate DirectorBoard Secretary Jan 1, 2022
Ivon Ruz Individual Corporate DirectorBoard Member Jan 1, 2022
Rich Glorioso Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458691200000",
    "number": "1144230640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14254 MARTIN LUTHER KING BLVD",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335274414",
            "telephone_number": "813-349-7700",
            "fax_number": "813-349-7761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14254 MARTIN LUTHER KING BLVD",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335274414",
            "telephone_number": "813-349-7700",
            "fax_number": "813-349-7761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCOAST COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2016-03-23",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "813-349-7563"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029523001",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tom Lee Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dover, FL

Sources for this page

Verify at the official NPI Registry.