NPIMap

Organization Active NPI

Community Health Connection, Inc.

Doing business as Community Health Connection KW

  • Federally Qualified Health Center (FQHC)
  • Tulsa, OK
National Provider Identifier
1255612040
Registry record updated Sep 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CONNECTION, INC.
Doing business as
Community Health Connection KW
Practice address
2321 E 3Rd Street
Tulsa, OK 74104
Phone
(918) 622-0641
Fax
(918) 622-4814
NPI assigned
Sep 7, 2011
Last updated
Sep 20, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2016

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

Authorized official

Name
Jeff Faust
Title
HR Manager
Phone
(918) 622-0641

Specialties & licenses 1

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

Addresses

Primary practice location

2321 E 3Rd Street
Tulsa, OK 74104

Mailing address

2321 E 3Rd Street
Tulsa, OK 74104
Phone (918) 622-0641

Other identifiers 1

IdentifierTypeStateIssuer
200082520BMedicaidOK

Other names 1

  • Community Health Connection KW Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111107000495 OK Part A Provider - Federally Qualified Health Center (FQHC) 5991756397 Practice locations: Tulsa, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255612040. Details of each certification follow.

Federally qualified health center certification: CCN 371873

Legal name
COMMUNITY HEALTH CONNECTION, INC.
Doing business as
K-W CLINICAL CONSTRUCTION PROJECT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 22, 2011
Last certification
Dec 22, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 2003 in OK
Enrollment address
2321 E 3Rd Street
K-W Clinical Construction Project
Tulsa, OK 74104-1831

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Community Health Connection Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Eduardo Martinez Individual Corporate Director Nov 18, 2011
Margaret T Bujold Individual Corporate Director Nov 18, 2011
Margarita Castaneda Individual Corporate Director Nov 18, 2011
Francisco J Trevino Individual Corporate Director Nov 18, 2011
Alex Foglietta Individual Corporate Director Nov 18, 2011
Elaine G Pikler Individual Corporate Director Nov 18, 2011
Chanteau Orr Combs Individual Corporate Director Nov 18, 2011
William James McCarthy Individual W-2 Managing EmployeeChief Executive Officer Nov 6, 2012 100%
Operational/Managerial ControlChief Executive Officer Nov 6, 2012 100%
Community Health Connection, Inc. Organization, Tulsa, OK Non-profit Operational/Managerial Control Nov 18, 2011
Terry J Weinacht Individual Corporate Director Nov 18, 2011
Kirk Wester Individual Corporate Director Nov 18, 2011

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1315353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474329600000",
    "number": "1255612040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2321 E 3RD STREET",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74104",
            "telephone_number": "918-622-0641",
            "fax_number": "918-622-4814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2321 E 3RD STREET",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74104",
            "telephone_number": "918-622-0641",
            "fax_number": "918-622-4814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CONNECTION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-07",
        "last_updated": "2016-09-20",
        "status": "A",
        "authorized_official_last_name": "FAUST",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "HR MANAGER",
        "authorized_official_telephone_number": "918-622-0641"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200082520B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Health Connection KW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.