NPIMap

Organization Active NPI

Community Health Centers of Southeastern Iowa Inc

  • Federally Qualified Health Center (FQHC)
  • West Burlington, IA
National Provider Identifier
1255339750
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC
Practice address
1706 West Agency Road
West Burlington, IA 52655
Phone
(319) 768-5858
Fax
(319) 752-4653
NPI assigned
Jul 8, 2005
Last updated
Jan 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2023

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

Authorized official

Name
Mr. Antonio Flores, CEO
Title
Ceo
Phone
(319) 768-5858

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 35097 IA
Internal Medicine Physician 207R00000X 37355 IA
Pediatrics Physician 208000000X 17758 IA
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Physician Assistant 363A00000X 000671 IA
Nurse Practitioner 363L00000X A045847 IA

Addresses

Primary practice location

1706 West Agency Road
West Burlington, IA 52655

Mailing address

1706 West Agency Road
West Burlington, IA 52655
Phone (319) 768-5858

Other identifiers 3

IdentifierTypeStateIssuer
0288175MedicaidIA
506089432MedicaidMO
35732OtherIABC/BS OF IOWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030313000012 IA Part A Provider - Federally Qualified Health Center (FQHC) 4486562527 Practice locations: West Burlington, IA
O20040219000446 IA Part B Supplier - Clinic/Group Practice 4486562527 Receives reassigned benefits from 40 practitioners
8 other NPIs on this enrollment
Practice locations: Burlington, IA; Columbus City, IA; Keokuk, IA; West Burlington, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255339750. Details of each certification follow.

Federally qualified health center certification: CCN 161819

Legal name
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC
Doing business as
COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 17, 2003
Last certification
Jun 17, 2003
Ownership / control type
Non-profit – other
Organization structure
CorporationNon-profit
Enrollment address
1706 W Agency Rd
West Burlington, IA 52655-1667

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Suzanne Sorensen Individual Corporate OfficerBoard Member Jan 25, 2018
William Staats Individual Corporate OfficerBoard Member Jul 8, 2004
David Haden Individual Corporate OfficerBoard Member Dec 22, 2022
Joseph Douglas Individual Corporate DirectorBoard Member Apr 25, 2024
Julie a Schilling Individual Corporate OfficerBoard Member Feb 21, 2006
Delaney Richards Individual Corporate OfficerBoard Member Jan 26, 2023
Misty Cale Individual Corporate DirectorBoard Member Dec 18, 2025
Dennis Fitzgibbon Individual Corporate DirectorBoard Member Jun 26, 2025
David Selmon Individual Corporate OfficerBoard Member Sep 27, 2021
William Grimm Individual Corporate OfficerCeo Aug 1, 2024
W-2 Managing EmployeeCeo Aug 1, 2024
Operational/Managerial ControlCeo May 19, 2023
Samuel Klein Individual Corporate DirectorBoard Member Jun 26, 2025
Jeffrey Strause Individual Corporate OfficerBoard Member Jan 25, 2018
Chuck Griffin Individual Corporate OfficerBoard Member Aug 22, 2013

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1255339750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1706 WEST AGENCY ROAD",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "52655",
            "telephone_number": "319-768-5858",
            "fax_number": "319-752-4653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1706 WEST AGENCY ROAD",
            "city": "WEST BURLINGTON",
            "state": "IA",
            "postal_code": "52655",
            "telephone_number": "319-768-5858",
            "fax_number": "319-752-4653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS OF SOUTHEASTERN IOWA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-08",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "ANTONIO",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "319-768-5858",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CEO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "35097",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IA",
            "license": "37355",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "17758",
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "000671",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "A045847",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0288175",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "506089432",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF IOWA",
            "identifier": "35732",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Burlington, IA

Sources for this page

Verify at the official NPI Registry.