NPIMap

Organization Active NPI

Charlotte Community Health Clinic, Inc.

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
National Provider Identifier
1215499520
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHARLOTTE COMMUNITY HEALTH CLINIC, INC.
Practice address
5301 Wilkinson Blvd Ste 1105
Charlotte, NC 28208-5455
Phone
(704) 316-6573
Fax
(704) 384-1977
NPI assigned
Apr 4, 2019
Organization subpart
Yes
Parent organization
CHARLOTTE COMMUNITY HEALTH CLINIC, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Lisa M Holmes
Title
Coo
Phone
(704) 316-6561

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

5301 Wilkinson Blvd Ste 1105
Charlotte, NC 28208-5455

Mailing address

5301 Wilkinson Blvd Ste 1105
Charlotte, NC 28208-5455
Phone (704) 316-6562

Other names 1

  • Charlotte Community Health Clinic Family Dentistry Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150626001703 NC Part B Supplier - Clinic/Group Practice 0840502274 Receives reassigned benefits from 32 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Charlotte Community Health Clinic Inc6 organizations share this tax ID, including this one
Part of
Charlotte Community Health Clinic Inc

Other organizations with this tax ID 5

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

Locations

5301 Wilkinson Blvd
Ste 1105
Charlotte, NC 28208
Phone (704) 316-6573

Practitioners & affiliated clinicians

Practitioners 5

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": "1554336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1215499520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 WILKINSON BLVD STE 1105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085455",
            "telephone_number": "704-316-6562",
            "fax_number": "704-384-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 WILKINSON BLVD STE 1105",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085455",
            "telephone_number": "704-316-6573",
            "fax_number": "704-384-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE COMMUNITY HEALTH CLINIC, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHARLOTTE COMMUNITY HEALTH CLINIC, INC",
        "enumeration_date": "2019-04-04",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "704-316-6561"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charlotte Community Health Clinic Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.