NPIMap

Organization Active NPI

Community Health Center of Pinellas Inc

  • Federally Qualified Health Center (FQHC)
  • St Petersburg, FL
National Provider Identifier
1194283382
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF PINELLAS INC
Practice address
1344 22ND St S
St Petersburg, FL 33712-2744
Phone
(727) 824-8181
NPI assigned
Mar 6, 2019
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CENTER OF PINELLAS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Authorized official

Name
Edward Kucher
Title
Chief Regulatory Officer
Phone
(727) 824-8100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1344 22ND St S
St Petersburg, FL 33712-2744

Mailing address

PO Box 10549
St Petersburg, FL 33733-0549
Phone (727) 824-8181

Other identifiers 2

IdentifierTypeStateIssuer
029565527MedicaidFL
029565528MedicaidFL

Other names 2

  • Community Health Center at Mobile Health Center Doing business as
  • Evara Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040131000031 FL Part B Supplier - Clinic/Group Practice 8527961028 Receives reassigned benefits from 135 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Largo, FL; Tarpon Springs, FL; St Petersburg, FL; Saint Petersburg, FL; Pinellas Park, FL; Dunedin, FL; Clearwater, FL
O20190719000907 FL Part A Provider - Federally Qualified Health Center (FQHC) 8527961028 Practice locations: St Petersburg, FL

Federally qualified health center certification: CCN 681149

Legal name
COMMUNITY HEALTH CENTER OF PINELLAS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 19, 2019
Last certification
Jul 19, 2019
Ownership / control type
For profit – individual
Organization structure
CorporationNon-profit
Incorporated
Feb 11, 1980 in FL
Enrollment address
1344 22ND St S
St Petersburg, FL 33712-2744

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 18

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

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Community Health Center24 organizations share this tax ID, including this one
Part of
Community Health Center

Other organizations with this tax ID 23

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

View all 23

Locations

612 Dr Martin Luther King Jr St N
St Petersburg, FL 33705

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Joseph Smith Individual Corporate DirectorChair Jun 1, 2019
Elodie Dorso Individual Corporate OfficerCeo Feb 28, 2018 100%
W-2 Managing EmployeeCeo Jan 1, 2005 100%
Alberto Lense Individual Corporate DirectorSecretary Jun 1, 2019
Cindy McNulty Individual Corporate DirectorVice Chair Jun 1, 2019
Frances Serrano Lux Individual Corporate DirectorPast Chair Jun 1, 2019
Edward Kucher Individual Corporate OfficerCoo Feb 28, 2018 100%
W-2 Managing EmployeeCoo Feb 27, 2017 100%

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1551830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749168000000",
    "number": "1194283382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10549",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337330549",
            "telephone_number": "727-824-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1344 22ND ST S",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337122744",
            "telephone_number": "727-824-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF PINELLAS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CENTER OF PINELLAS INC",
        "enumeration_date": "2019-03-06",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A",
        "authorized_official_last_name": "KUCHER",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "CHIEF REGULATORY OFFICER",
        "authorized_official_telephone_number": "727-824-8100"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029565527",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029565528",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Center at Mobile Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Health Center at Mobile Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evara Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.