NPIMap

Organization Active NPI

Maple City Health Care Center, Inc

Doing business as Westend Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Goshen, IN
National Provider Identifier
1275220303
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MAPLE CITY HEALTH CARE CENTER, INC
Doing business as
Westend Community Health Center
Practice address
2606 Peddlers Village Rd Ste 210
Goshen, IN 46526-1004
Phone
(574) 534-0088
NPI assigned
Apr 19, 2023
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MAPLE CITY HEALTH CARE CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Authorized official

Name
Karen Miller Rush
Title
Director of Finance
Phone
(574) 534-0088

Specialties & licenses 1

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

Addresses

Primary practice location

2606 Peddlers Village Rd Ste 210
Goshen, IN 46526-1004

Mailing address

213 Middlebury St
Goshen, IN 46528-2956
Phone (574) 534-3300

Other names 1

  • Westend Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110615000145 IN Part B Supplier - Clinic/Group Practice 2163569401 Receives reassigned benefits from 34 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Goshen, IN
O20230706001005 IN Part A Provider - Federally Qualified Health Center (FQHC) 2163569401 Practice locations: Goshen, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275220303. Details of each certification follow.

Federally qualified health center certification: CCN 151195

Legal name
MAPLE CITY HEALTH CARE CENTER INC
Doing business as
WESTEND COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 5, 2023
Last certification
Jul 5, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 10, 1988 in IN
Enrollment address
2606 Peddlers Village Rd
Ste 210
Goshen, IN 46526-1004

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Maple City Health Care4 organizations share this tax ID, including this one
Part of
Maple City Health Care

Other organizations with this tax ID 3

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

Locations

2606 Peddlers Village Rd
Ste 210
Goshen, IN 46526
Phone (260) 602-3276

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Miguel Millan Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Karen M Rush Individual Corporate OfficerCfo Aug 1, 2012
W-2 Managing EmployeeDirector of Finance Aug 1, 2012
Jenny Martinez Individual Operational/Managerial ControlBoard Secretary Jan 1, 2022
Adam Scharf Individual Operational/Managerial ControlBoard Treasurer Jan 1, 2022
Paul Shetler Fast Individual Corporate Director Sep 14, 2022 1%
W-2 Managing EmployeeExecutive Director Sep 14, 2022
Kevin Farmwald Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Sarah Metzler Individual Operational/Managerial ControlBoard President Jan 1, 2022
Max R Mertz Individual Operational/Managerial ControlBoard Vice President Jan 1, 2022
Denise Mettert Individual Operational/Managerial ControlBoard Member Jan 1, 2022

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 33

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 33

NPI Registry JSON

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

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1275220303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 MIDDLEBURY ST",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465282956",
            "telephone_number": "574-534-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2606 PEDDLERS VILLAGE RD STE 210",
            "city": "GOSHEN",
            "state": "IN",
            "postal_code": "465261004",
            "telephone_number": "574-534-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAPLE CITY HEALTH CARE CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAPLE CITY HEALTH CARE CENTER, INC",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MILLER",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "574-534-0088"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Westend Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Goshen, IN

Sources for this page

Verify at the official NPI Registry.