NPIMap

Organization Active NPI

Charles Drew Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
National Provider Identifier
1154895225
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHARLES DREW HEALTH CENTER INC
Practice address
5319 N 30TH St Ste a
Omaha, NE 68111-1604
Phone
(402) 457-1216
Fax
(402) 453-2061
NPI assigned
Jan 11, 2019
Organization subpart
Yes
Parent organization
CHARLES DREW HEALTH CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Mr. Andre Stringfellow
Title
Chief Financial Officer
Phone
(402) 457-1215

Specialties & licenses 1

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

Addresses

Primary practice location

5319 N 30TH St Ste a
Omaha, NE 68111-1604

Mailing address

2915 Grant St
Omaha, NE 68111-3863
Phone (402) 810-9762

Other identifiers 2

IdentifierTypeStateIssuer
10026276413OtherNEMEDICAID NON FQHC
10026276407MedicaidNE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190307000230 NE Part A Provider - Federally Qualified Health Center (FQHC) 9830170653 Practice locations: Omaha, NE

Federally qualified health center certification: CCN 281848

Legal name
CHARLES DREW HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 5, 2019
Last certification
Mar 5, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1973 in NE
Enrollment address
5319 N 30TH St
Ste a
Omaha, NE 68111-1604

Other NPIs with the same Medicare PAC ID 11

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

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
28D2161144Charles Drew Health Center, Inc at 305319 N 30TH Street, Suite a, Omaha, NE 68111Provider-performed microscopyJan 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Benson Community Health Center19 organizations share this tax ID, including this one
Part of
Benson Community Health Center

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Kenny McMorris Individual 5% Or Greater Direct Ownership InterestCeo Jan 1, 2016 20%
Corporate DirectorCeo Jan 1, 2016 20%
W-2 Managing EmployeeCeo Jan 1, 2016 20%
Andre Stringfellow Individual 5% Or Greater Direct Ownership InterestCfo Dec 1, 2023 20%

NPI Registry JSON

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1154895225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 GRANT ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681113863",
            "telephone_number": "402-810-9762",
            "fax_number": "402-939-0916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5319 N 30TH ST STE A",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681111604",
            "telephone_number": "402-457-1216",
            "fax_number": "402-453-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLES DREW HEALTH CENTER INC",
        "enumeration_date": "2019-01-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "STRINGFELLOW",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID NON FQHC",
            "identifier": "10026276413",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026276407",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.