NPIMap

Organization Active NPI

Peak Vista Community Health Centers

Doing business as Health Center at 340 Printers Parkway

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
National Provider Identifier
1194276105
Registry record updated Mar 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
Health Center at 340 Printers Parkway
Practice address
340 Printers Pkwy
Colorado Springs, CO 80910
Phone
(719) 632-5700
Fax
(719) 344-7863
NPI assigned
Oct 14, 2016
Last updated
Mar 6, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PEAK VISTA COMMUNITY HEALTH CENTERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2023

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

Authorized official

Name
Ryan Spillane
Title
Chief Financial Officer
Phone
(719) 344-7135

Specialties & licenses 1

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

Addresses

Primary practice location

340 Printers Pkwy
Colorado Springs, CO 80910

Mailing address

3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917
Phone (719) 632-5700

Other identifiers 2

IdentifierTypeStateIssuer
9000156971MedicaidCO
05638267MedicaidCO

Other names 1

  • Health Center at 340 Printers Parkway Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171115000311 CO Part A Provider - Federally Qualified Health Center (FQHC) 4688583974 Practice locations: Colorado Springs, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194276105. Details of each certification follow.

Federally qualified health center certification: CCN 061979

Legal name
PEAK VISTA COMMUNITY HEALTH CENTERS
Doing business as
HEALTH CENTER AT 340 PRINTERS PARKWAY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 14, 2017
Last certification
Nov 14, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 2016 in CO
Enrollment address
340 Printers Pkwy
Colorado Springs, CO 80910-3190

Other NPIs with the same Medicare PAC ID 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Community Health Ctr Co27 organizations share this tax ID, including this one
Part of
Community Health Ctr Co

Other organizations with this tax ID 26

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

View all 26

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
William C Sanden Individual Corporate DirectorBoard Member Jan 1, 2019
Ray Nunn Individual Corporate DirectorBoard Member Oct 1, 2019
Ryan Spillane Individual Corporate OfficerChief Financial Officer Sep 26, 2022
Dennis Smialek Individual Corporate DirectorBoard Member Mar 3, 2020
Santiago R Duran Individual Corporate DirectorBoard Member Sep 6, 2017
Clifton R Turner Individual Corporate DirectorBoard Member Dec 4, 2018
Gertrud M Horvath Individual Corporate DirectorBoard Member Feb 7, 2017
Mary M Sheetz Individual Corporate DirectorBoard Member Jan 9, 2018
Rodrigo Villazon Individual Corporate DirectorBoard Member Sep 6, 2017
Robin E Johnson Individual Corporate DirectorBoard Member Jan 9, 2019
Denise Smith Silva Individual W-2 Managing EmployeeBusiness Systems Manager Mar 31, 1987
Pamela Ann Taylor Individual Corporate DirectorBoard Member Feb 1, 2019
Victoria R Stone Individual Other Sep 1, 2016

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Mobile Health Services VanColorado Springs, CO, CCN 061909 Federally qualified health center 5% Or Greater Direct Ownership Interest Mar 15, 2012
Logan Health Center at Myron StrattonColorado Springs, CO, CCN 061914 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012
Pediatric Health CenterColorado Springs, CO, CCN 061917 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 5, 2012

Owned or controlled facilities with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1476403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1194276105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD",
            "address_2": "SUITE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80917",
            "telephone_number": "719-632-5700",
            "fax_number": "719-344-7865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 PRINTERS PKWY",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80910",
            "telephone_number": "719-632-5700",
            "fax_number": "719-344-7863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
        "enumeration_date": "2016-10-14",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-06",
        "status": "A",
        "authorized_official_last_name": "SPILLANE",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "719-344-7135"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000156971",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638267",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Center at 340 Printers Parkway",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Health Center at 340 Printers Parkway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.