NPIMap

Organization Active NPI

Cincinnati Health Network, Inc

  • Federally Qualified Health Center (FQHC)
  • Cincinnati, OH
National Provider Identifier
1154776979
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CINCINNATI HEALTH NETWORK, INC
Practice address
411 Gest St Ste 1
Cincinnati, OH 45203-1731
Phone
(513) 386-7899
Fax
(513) 352-6379
NPI assigned
Apr 29, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Austin Maddox, CPA
Title
Cfo
Phone
(513) 961-0600

Specialties & licenses 1

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

Addresses

Primary practice location

411 Gest St Ste 1
Cincinnati, OH 45203-1731

Mailing address

40 E McMicken Ave Ste 3
Cincinnati, OH 45202-6626
Phone (513) 961-0600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160809001866 OH Part A Provider - Federally Qualified Health Center (FQHC) 2062678758 Practice locations: Cincinnati, OH

Federally qualified health center certification: CCN 361109

Legal name
CINCINNATI HEALTH NETWORK, INC
Doing business as
SHELTERHOUSE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 4, 2016
Last certification
Aug 4, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 29, 1986 in OH
Enrollment address
411 Gest St
Ste 1
Cincinnati, OH 45203-1731

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Cincinnati Health Network Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

411 Gest St
Ste 1
Cincinnati, OH 45203
Phone (513) 386-7899

2825 Burnet Ave
Ste 234
Cincinnati, OH 45219

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15958/brand/2/csg/1/fhir/r4

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Mona Jenkins Individual Corporate DirectorBoard Member Oct 1, 2017
Mathew Jackson Individual Corporate DirectorBoard Member Oct 1, 2008
Cincinnati Health Network, Inc Organization, Cincinnati, OH Non-profit 5% Or Greater Direct Ownership Interest Sep 5, 1986
Valorie Costello Individual Corporate DirectorBoard Member Mar 1, 2016
Sandra Driggins-Smith Individual Corporate DirectorBoard Member May 1, 2018
Jerry Bedford Individual Corporate DirectorBoard Chair Oct 1, 2006
Kelly Dunnigan Individual Corporate DirectorBoard Member May 11, 2016
Brian Vanderhorst Individual Corporate OfficerCeo Sep 1, 2021
Operational/Managerial ControlCeo Sep 1, 2021
Toni Winston Individual Corporate DirectorBoard Secretary Apr 1, 2014
John Cobey Individual Corporate DirectorBoard Member Feb 1, 2017
Taylor Jenkins Individual Corporate DirectorBoard Treasurer Oct 1, 2014
Ronald Hector Individual Corporate DirectorBoard Member Nov 1, 2010

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Cincinnati Health Network, IncCincinnati, OH, CCN 361014 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Sep 5, 1986

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1154776979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 E MCMICKEN AVE STE 3",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452026626",
            "telephone_number": "513-961-0600",
            "fax_number": "513-961-0643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 GEST ST STE 1",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452031731",
            "telephone_number": "513-386-7899",
            "fax_number": "513-352-6379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CINCINNATI HEALTH NETWORK, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-29",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "AUSTIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "513-961-0600",
        "authorized_official_credential": "CPA"
    },
    "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 Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.