NPIMap

Organization Active NPI

Lower Lights Christian Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Newark, OH
National Provider Identifier
1144892472
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Practice address
69 S Terrace Ave
Newark, OH 43055
Phone
(614) 274-1455
Fax
(614) 274-1433
NPI assigned
Jul 15, 2021
Last updated
Jun 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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

Authorized official

Name
Shelly Maurey
Title
Credentialing Specialist
Phone
(614) 274-1455

Specialties & licenses 1

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

Addresses

Primary practice location

69 S Terrace Ave
Newark, OH 43055

Mailing address

1160 W Broad St
Columbus, OH 43222-1352
Phone (614) 274-1455

Other identifiers 1

IdentifierTypeStateIssuer
0477562MedicaidOH

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL LLCHC.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210915002687 OH Part A Provider - Federally Qualified Health Center (FQHC) 5193794188 Practice locations: Newark, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144892472. Details of each certification follow.

Federally qualified health center certification: CCN 721940

Legal name
LOWER LIGHTS CHRISTIAN HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 19, 2022
Last certification
Jan 19, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 15, 2001 in OH
Enrollment address
69 S Terrace Ave
Newark, OH 43055-1355

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Lower Lights Christian HLTH13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

1560 S High St
Columbus, OH 43207
Phone 61427414556220

777 W State St
Ste 201A
Columbus, OH 43222

69 S Terrace Ave
Newark, OH 43055
Phone 61427414556231

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
Michelle Love Individual Corporate DirectorBoard Member Jan 5, 2017
Jason Koma Individual Corporate DirectorBoard Member Jan 5, 2017
Linda Hines Individual Corporate DirectorBoard Member Jan 5, 2017
Tracy Cloud Individual Corporate OfficerCeo Mar 1, 2018
W-2 Managing EmployeeCeo Mar 1, 2018
Kelley Oneil Individual Corporate DirectorBoard Member Jan 5, 2017
Melodie Gee Individual Corporate OfficerCqo Board Member Jan 5, 2018
Corporate DirectorCqo Jan 5, 2017
W-2 Managing EmployeeCqo Jan 5, 2017
Pauline Edwards Individual Corporate DirectorBoard Member Jan 5, 2017
Jennifer Higgins Individual Corporate DirectorBoard Member Jan 5, 2017
Terry Arnet Individual Corporate DirectorBoard Member Jan 5, 2017
Ellen Baugh Individual Corporate DirectorBoard Member Jan 5, 2017
Elizabeth Bitonte Individual Corporate DirectorBoard Member Jan 5, 2017
Michael Corey Individual Corporate DirectorBoard Member Jan 5, 2017
Jennifer Diamond Individual Corporate DirectorBoard Member Jan 5, 2017
Rita Monroe Individual Corporate DirectorBoard Member Jan 5, 2017

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Lower Lights Christian Health Center IncColumbus, OH, CCN 361011 Federally qualified health center Operational/Managerial Control Nov 15, 2001

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1144892472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432221352",
            "telephone_number": "614-274-1455",
            "fax_number": "614-274-1433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 S TERRACE AVE",
            "city": "NEWARK",
            "state": "OH",
            "postal_code": "43055",
            "telephone_number": "614-274-1455",
            "fax_number": "614-274-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOWER LIGHTS CHRISTIAN HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-15",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "MAUREY",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "614-274-1455"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0477562",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "LLCHC.org",
            "affiliation": "N",
            "address_1": "69 S Terrace Ave",
            "city": "Newark",
            "state": "OH",
            "country_code": "US",
            "postal_code": "43055",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newark, OH

Sources for this page

Verify at the official NPI Registry.