NPIMap

Organization Active NPI

Community Health Connections, Inc.

Doing business as South Gardner Community Health Center and Urgent Care

  • Federally Qualified Health Center (FQHC)
  • Gardner, MA
National Provider Identifier
1225742174
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CONNECTIONS, INC.
Doing business as
South Gardner Community Health Center and Urgent Care
Practice address
529 Timpany Boulevard
Gardner, MA 01440
Phone
(978) 878-8100
NPI assigned
Jan 5, 2023
Last updated
Jan 5, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY HEALTH CONNECTIONS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Authorized official

Name
John A Demalia
Title
Ceo
Phone
(978) 878-8510

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

529 Timpany Boulevard
Gardner, MA 01440

Mailing address

326 Nichols Rd
Fitchburg, MA 01420-1914
Phone (978) 878-8100

Other names 1

  • South Gardner Community Health Center and Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040422001136 MA Part B Supplier - Clinic/Group Practice 8729074992 Receives reassigned benefits from 138 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fitchburg, MA; Leominster, MA; Gardner, MA
O20230830003453 MA Part A Provider - Federally Qualified Health Center (FQHC) 8729074992 Practice locations: Gardner, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225742174. Details of each certification follow.

Federally qualified health center certification: CCN 221005

Legal name
COMMUNITY HEALTH CONNECTIONS, INC
Doing business as
SOUTH GARDNER COMMUNITY HEALTH CENTER AND URGENT CARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 30, 2023
Last certification
Aug 30, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 15, 2023 in MA
Enrollment address
529 Timpany Blvd
Gardner, MA 14403451

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
22D2275935South Gardner Community Health and529 Timpany Blvd, Gardner, MA 01440Certificate of waiverJan 30, 2027

National Provider Directory

National Provider Directory
Tax ID family
Christen Cage MD3 organizations share this tax ID, including this one
Part of
Christen Cage MD

Other organizations with this tax ID 2

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

Locations

130 Water St
Ste 4
Fitchburg, MA 01420
Phone (978) 868-9944

140 Arnhow Farm Rd
Fitchburg, MA 01420
Phone (978) 345-3240

250 Green St
Ste 205A
Gardner, MA 01440
Phone (978) 630-5751

14 Manning Ave
Ste 402
Leominster, MA 01453
Phone (978) 847-0110

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Tara Rivera Individual Corporate DirectorBoard Member Jun 25, 2018
Melissa Maranda Individual Corporate DirectorBoard Member Mar 23, 2020
Emily Macrae Individual Corporate DirectorBoard Member Mar 28, 2016
Cindy Cadoret Individual Corporate DirectorBoard Member Oct 23, 2017
John a Demalia Individual Corporate OfficerCeo Sep 13, 2013
Corporate DirectorCeo Sep 13, 2013
W-2 Managing EmployeeCeo Sep 13, 2013
Irene Hernandez Individual Corporate DirectorBoard Member Oct 23, 2017
Maribel Cruz Individual Corporate DirectorBoard Member Mar 25, 2019
Daniel Cunningham Individual Corporate DirectorBoard Member Mar 23, 2020
Jane Crocker Individual Corporate DirectorBoard Member Mar 23, 2015
Patrick B Lavelle Individual Corporate OfficerCfo Nov 11, 2013
Corporate DirectorCfo Nov 11, 2013
W-2 Managing EmployeeCfo Nov 11, 2013
Chelsey Patriss Individual Corporate DirectorBoard Member Jun 25, 2018
Shawn Hayden Individual Corporate DirectorBoard Member Dec 16, 2019
Roderick W Lewin Individual Corporate DirectorBoard Member Oct 23, 2017
Raymond Lafond Individual Corporate DirectorBoard Member Jan 24, 2022

Practitioners & affiliated clinicians

Practitioners 141

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 141

NPI Registry JSON

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

{
    "created_epoch": "1672876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672876800000",
    "number": "1225742174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 NICHOLS RD",
            "city": "FITCHBURG",
            "state": "MA",
            "postal_code": "014201914",
            "telephone_number": "978-878-8100",
            "fax_number": "978-878-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 TIMPANY BOULEVARD",
            "city": "GARDNER",
            "state": "MA",
            "postal_code": "01440",
            "telephone_number": "978-878-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CONNECTIONS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY HEALTH CONNECTIONS, INC.",
        "enumeration_date": "2023-01-05",
        "last_updated": "2023-01-05",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "DEMALIA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "978-878-8510"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Gardner Community Health Center and Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gardner, MA

Sources for this page

Verify at the official NPI Registry.