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Organization Active NPI

Charles Drew Health Center, Inc

Doing business as Charles Drew Health Center, Inc at Grant Street

  • Federally Qualified Health Center (FQHC)
  • Omaha, NE
National Provider Identifier
1255302170
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHARLES DREW HEALTH CENTER, INC
Doing business as
Charles Drew Health Center, Inc at Grant Street
Practice address
2915 Grant Street
Omaha, NE 68111-3863
Phone
(402) 451-3553
Fax
(402) 457-1220
NPI assigned
Jan 30, 2006
Last updated
Jul 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Mr. Andre Stringfellow
Title
Chief Financial Officer
Phone
(402) 457-1215

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Community Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC1500X
Community Health Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WC1500X NE
Community Health Clinic/Center 261QC1500X NE
Federally Qualified Health Center (FQHC) 261QF0400X NE Primary

Addresses

Primary practice location

2915 Grant Street
Omaha, NE 68111-3863

Mailing address

PO Box 30019
2915 Grant Street
Omaha, NE 68103-1119
Phone (402) 451-3553

Other names 1

  • Charles Drew Health Center, Inc at Grant Street Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040527000621 NE Part B Supplier - Clinic/Group Practice 9830170653 Receives reassigned benefits from 68 practitioners
Practice locations: Omaha, NE
O20080819000723 NE Part A Provider - Federally Qualified Health Center (FQHC) 9830170653 Practice locations: Omaha, NE

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255302170. Details of each certification follow.

Federally qualified health center certification: CCN 281802

Legal name
CHARLES DREW HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 1, 1992
Last certification
Jan 1, 1992
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1984 in NE
Enrollment address
2915 Grant St
Omaha, NE 68111-3863

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory

Locations

3706 Maple St
Omaha, NE 68111
Phone (402) 457-5723

5120 Maple St
Ste 101
Omaha, NE 68104
Phone (402) 451-3553

5190 Sprague Plz
Ste 100
Omaha, NE 68104

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Julieta Clarke Individual Corporate Director Apr 3, 2007
Kenny McMorris Individual Corporate DirectorChief Executive Officer Aug 3, 2009 20%
Eric Payne Individual Corporate Director Apr 13, 2007
Elizabeth Campbell Individual Corporate Director Apr 3, 2007
Patricia Brown Individual Corporate Director Apr 3, 2007
Andy Lanik Individual Corporate Director Apr 13, 2007
Richard L Brown Individual Corporate Director Sep 30, 2008
Mike Saklar Individual Corporate Director Apr 13, 2007
Tarsha Jackson Individual Corporate DirectorChief Financial Officer May 12, 2014 20%
W-2 Managing EmployeeChief Financial Officer May 12, 2014 20%
Rick Bell Individual Corporate Director Apr 3, 2007

Practitioners & affiliated clinicians

Practitioners 71

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 71

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1255302170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30019",
            "address_2": "2915 GRANT STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681031119",
            "telephone_number": "402-451-3553",
            "fax_number": "402-457-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2915 GRANT STREET",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681113863",
            "telephone_number": "402-451-3553",
            "fax_number": "402-457-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES DREW HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "STRINGFELLOW",
        "authorized_official_first_name": "ANDRE",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "402-457-1215",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NE",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charles Drew Health Center, Inc at Grant Street",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Charles Drew Health Center, Inc at Grant Street",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.