NPIMap

Organization Active NPI

Collier Health Services Inc

Doing business as Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Immokalee, FL
National Provider Identifier
1194919993
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COLLIER HEALTH SERVICES INC
Doing business as
Healthcare Network
Practice address
1441 Heritage Blvd
Immokalee, FL 34142-2260
Phone
(239) 658-3000
NPI assigned
Sep 5, 2007
Last updated
Oct 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Authorized official

Name
Tami Raznoff
Title
Cfo
Phone
(239) 986-0136

Specialties & licenses 1

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

Addresses

Primary practice location

1441 Heritage Blvd
Immokalee, FL 34142-2260

Mailing address

1454 Madison Ave W
Immokalee, FL 34142-2200
Phone (239) 658-3000

Other identifiers 1

IdentifierTypeStateIssuer
683955012MedicaidFL

Other names 1

  • Healthcare Network Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090106000632 FL Part A Provider - Federally Qualified Health Center (FQHC) 4183521925 Practice locations: Immokalee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194919993. Details of each certification follow.

Federally qualified health center certification: CCN 101005

Legal name
COLLIER HEALTH SERVICES, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 19, 2009
Last certification
Mar 19, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 17, 1977 in FL
Enrollment address
1441 Heritage Blvd
Immokalee, FL 34142-2260

Other NPIs with the same Medicare PAC ID 24

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

View all 24

National Provider Directory

National Provider Directory
Tax ID family
Collier Health Services79 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jamie Ulmer Individual Corporate OfficerCeo Jan 1, 2024
Haris Domond Individual Corporate DirectorBoard Member Apr 17, 2012 100%
Kerri Ervin Individual Corporate DirectorBoard Member Jun 24, 2021
Maria Munguia Individual Corporate DirectorBoard Member Jan 1, 2024
John Fletcher Individual Corporate OfficerChief Operating Officer Oct 18, 2021 100%
Tami Raznoff Individual Corporate OfficerCfo May 1, 2019 100%
W-2 Managing EmployeeCfo May 1, 2019 100%
Dennis Brown Individual Corporate DirectorBoard Member Jul 31, 2019
Suzanne Bradach Individual Corporate DirectorBoard Member Sep 27, 2018
Jean Casnel Paul Individual Corporate Director Dec 2, 2008
Alejandro Castano Individual Corporate DirectorBoard Member Jul 22, 2021
Jerry Starkey Individual Corporate DirectorBoard Member Apr 17, 2014
James Douglas Campbell Individual Corporate DirectorBoard Member Jun 21, 2011

Practitioners & affiliated clinicians

Practitioners 91

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.

View all 91

NPI Registry JSON

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729036800000",
    "number": "1194919993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 MADISON AVE W",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422200",
            "telephone_number": "239-658-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 HERITAGE BLVD",
            "city": "IMMOKALEE",
            "state": "FL",
            "postal_code": "341422260",
            "telephone_number": "239-658-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLIER HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A",
        "authorized_official_last_name": "RAZNOFF",
        "authorized_official_first_name": "TAMI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "239-986-0136"
    },
    "taxonomies": [
        {
            "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": "683955012",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Healthcare Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Immokalee, FL

Sources for this page

Verify at the official NPI Registry.