NPIMap

Organization Active NPI

Community Health Centers of Southeastern Iowa, Inc

  • Federally Qualified Health Center (FQHC)
  • West Burlington, IA
National Provider Identifier
1164023255
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC
Practice address
1223 S Gear Ave Ste 108
West Burlington, IA 52655-1685
Phone
(319) 753-5177
NPI assigned
Nov 4, 2020
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2023

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

Authorized official

Name
Antonio Flores, CEO
Title
Ceo
Phone
(319) 768-5858

Specialties & licenses 1

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

Addresses

Primary practice location

1223 S Gear Ave Ste 108
West Burlington, IA 52655-1685

Mailing address

1706 W Agency Rd
West Burlington, IA 52655-1667
Phone (319) 768-5858

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000446 IA Part B Supplier - Clinic/Group Practice 4486562527 Receives reassigned benefits from 40 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burlington, IA; Columbus City, IA; Keokuk, IA; West Burlington, IA
O20230228002035 IA Part A Provider - Federally Qualified Health Center (FQHC) 4486562527 Practice locations: West Burlington, IA

Federally qualified health center certification: CCN 161006

Legal name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 24, 2023
Last certification
Feb 24, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1223 S Gear Ave
Ste 108
West Burlington, IA 52655-1685

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Part of
Community Health Center

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
Suzanne Sorensen Individual Corporate DirectorBoard Member May 28, 2020
William Staats Individual Corporate DirectorBoard Member Jul 1, 2004
David Haden Individual Corporate DirectorBoard Member Jan 26, 2023
Joseph Douglas Individual Corporate DirectorBoard Member Apr 25, 2024
Julie a Schilling Individual Corporate DirectorBoard Member Feb 1, 2006
Delaney Richards Individual Corporate DirectorBoard Member Jan 26, 2023
Misty Cale Individual Corporate DirectorBoard Member Dec 18, 2025
Dennis Fitzgibbon Individual Corporate DirectorBoard Member Jun 26, 2025
David Selmon Individual Corporate DirectorBoard Member Sep 27, 2021
William Grimm Individual Corporate OfficerCeo Aug 1, 2024
W-2 Managing EmployeeCeo Aug 1, 2024
Operational/Managerial ControlCeo Aug 1, 2024
Samuel Klein Individual Corporate DirectorBoard Member Jun 26, 2025
Jeffrey Strause Individual Corporate DirectorBoard Member Jan 25, 2018
Chuck Griffin Individual Corporate DirectorBoard Member Aug 22, 2013

NPI Registry JSON

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

{
    "created_epoch": "1604448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1164023255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 W AGENCY RD",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551667",
            "telephone_number": "319-768-5858",
            "fax_number": "319-753-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1223 S GEAR AVE STE 108",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "526551685",
            "telephone_number": "319-753-5177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC",
        "enumeration_date": "2020-11-04",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-768-5858",
        "authorized_official_credential": "CEO"
    },
    "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 West Burlington, IA

Sources for this page

Verify at the official NPI Registry.