NPIMap

Organization Active NPI

Wheeler Clinic Inc.

  • Federally Qualified Health Center (FQHC)
  • Bristol, CT
National Provider Identifier
1164987301
Registry record updated Sep 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WHEELER CLINIC INC.
Practice address
225 N Main St
Bristol, CT 06010-4926
Phone
(860) 793-3500
NPI assigned
Feb 1, 2019
Last updated
Sep 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Authorized official

Name
Athena Szczesniak
Title
Chief Financial Officer
Phone
(860) 793-4235

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Health Service Clinic/Center 261QH0100X NU

Addresses

Primary practice location

225 N Main St
Bristol, CT 06010-4926

Mailing address

91 Northwest Dr
Plainville, CT 06062-1534

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190325000595 CT Part A Provider - Federally Qualified Health Center (FQHC) 0345147153 Practice locations: Bristol, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164987301. Details of each certification follow.

Federally qualified health center certification: CCN 071940

Legal name
WHEELER CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 2019
Last certification
Apr 1, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 8, 1968 in CT
Enrollment address
225 N Main St
Bristol, CT 60104926

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
Wheeler Clinic Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Rachel M Tressy Individual Corporate Director Dec 18, 2018
Patricia a Duclos-Miller Individual Corporate Director Feb 25, 2020
Francis L Vincent Individual Corporate Director Jan 27, 2015
Gary J Thomas Individual Corporate Director Apr 27, 2010
Brian O'Donnell Individual Corporate Director Mar 26, 2019
Mary C Rodier Individual Corporate Director Mar 24, 2015
Charles J Herbert Individual Corporate Director Sep 11, 2015
Myron Stewart Individual Corporate Director Jun 23, 2020
Julie Vigil Individual Corporate Director Nov 17, 2020
Marian Acker Individual Corporate Director Jan 22, 2019
Sabrina Trocchi Individual Corporate OfficerPresident/Ceo Nov 1, 2019
Operational/Managerial ControlPresident/Ceo Nov 1, 2019 100%
Dennis Williams Individual Corporate Director Jun 23, 2020
Christine Elizabeth Skelly Individual Corporate Director Oct 26, 2010
Hyekyung Yang Individual Corporate Director May 28, 2019
Melissa a Barton Individual Corporate Director Oct 23, 2018
Athena Szczesniak Individual Corporate OfficerCheif Financial Office Jan 25, 2017
Gawdys Grullon Individual Corporate Director Jun 22, 2021
Mary R Connolly Individual Corporate Director Mar 27, 2018
Lee I Hoffman Individual Corporate Director Mar 23, 2020
Dawn Hinckley Individual W-2 Managing EmployeeRevenue Cycle Administrator Mar 24, 2004

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1548979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599782400000",
    "number": "1164987301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "91 NORTHWEST DR",
            "city": "PLAINVILLE",
            "state": "CT",
            "postal_code": "060621534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 N MAIN ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060104926",
            "telephone_number": "860-793-3500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHEELER CLINIC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-01",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A",
        "authorized_official_last_name": "SZCZESNIAK",
        "authorized_official_first_name": "ATHENA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "860-793-4235"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, CT

Sources for this page

Verify at the official NPI Registry.