NPIMap

Organization Active NPI

Detroit Community Health Connection, Inc

  • Federally Qualified Health Center (FQHC)
  • Detroit, MI
National Provider Identifier
1275796468
Registry record updated Apr 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
DETROIT COMMUNITY HEALTH CONNECTION, INC
Doing business as
Dr Sophie Womack Health Center
Practice address
7900 Kercheval St
Detroit, MI 48214-2439
Phone
(313) 921-5500
Fax
(313) 921-5530
NPI assigned
Jul 8, 2008
Organization subpart
Yes
Parent organization
DETROIT COMMUNITY HEALTH CONNECTION, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 26, 2013

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

Authorized official

Name
Mr. Mahipal Rao Kakarala
Title
Sr VP/Cfo
Phone
(313) 821-2591

Specialties & licenses 1

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

Addresses

Primary practice location

7900 Kercheval St
Detroit, MI 48214-2439

Mailing address

13901 E Jefferson Ave
Detroit, MI 48215-2720
Phone (313) 821-2591

Other names 1

  • Dr Sophie Womack Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326000067 MI Part B Supplier - Clinic/Group Practice 9234021148 Receives reassigned benefits from 23 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Detroit, MI
O20080718000650 MI Part A Provider - Federally Qualified Health Center (FQHC) 9234021148 Practice locations: Detroit, MI

Federally qualified health center certification: CCN 231937

Legal name
DETROIT COMMUNITY HEALTH CONNECTION INC
Doing business as
DR SOPHIE WOMACK HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 18, 2008
Last certification
Aug 18, 2008
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Enrollment address
7900 Kercheval St
Detroit, MI 48214-2439

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Tax ID family
Detroit Community Health Connection9 organizations share this tax ID, including this one
Part of
Detroit Community Health Connection

Other organizations with this tax ID 8

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

Locations

13901 E Jefferson Ave
Detroit, MI 48215
Phone (313) 821-2591

7900 Kercheval St
Detroit, MI 48214
Phone (313) 921-5500

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Patrick O Lindsey Individual Corporate DirectorSecretary Oct 27, 2015
Hallistine Stewart Individual Corporate Director Oct 27, 2015
Derek Ware Individual Corporate DirectorPresident &Ceo Sep 13, 2024
W-2 Managing Employee Sep 13, 2024
Crystal R Gardner-Martin Individual Corporate Director May 17, 2024
Henry Tokarz Individual Corporate OfficerVice President & Cfo Mar 3, 2025
W-2 Managing Employee Mar 3, 2025
Henry C Conerway Individual Corporate DirectorVice Chairperson Jul 27, 2021
Linda J Bowie Individual Corporate Director Jul 27, 2021
Mable Jones Individual Corporate Director Feb 27, 2025
Patricia a Wilkerson-Uddyback Individual W-2 Managing EmployeeChief Medical Officer Feb 26, 2024
Gwendolyn J Scales Individual Corporate DirectorBoard Member Nov 1, 2009
Thomas E Hardiman Individual Corporate Director Jul 27, 2021
Louise Guyton Individual Corporate DirectorTreasurer of the Board Jan 1, 2003
Paul Bridgewater Individual Corporate DirectorBoard Chairperson Sep 1, 2007
Eric B Scott Individual Corporate Director Dec 1, 2024
Vanessa Holsey Individual Corporate Director Sep 1, 2024
Detroit Community Health Connection Inc Organization, Detroit, MI Operational/Managerial Control Apr 1, 1998 100%
Gregory a Jones Individual Corporate Director Oct 27, 2015

Owners & managing parties with NPI records 8

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

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Woodward Corridor Family Medical CenterDetroit, MI, CCN 231936 Federally qualified health center Operational/Managerial Control (100%) Apr 18, 1997
Dr Feleta Wilson Health CenterDetroit, MI, CCN 231935 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 1998
Nolan Family Health CenterDetroit, MI, CCN 231934 Federally qualified health center Operational/Managerial Control Feb 11, 2004
Oscar Paskal Health CenterDetroit, MI, CCN 231015 Federally qualified health center Operational/Managerial Control Aug 11, 2011
Dr Peter Slaughter Health CenterDetroit, MI, CCN 231139 Federally qualified health center Operational/Managerial Control Dec 12, 2018

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366934400000",
    "number": "1275796468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13901 E JEFFERSON AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482152720",
            "telephone_number": "313-821-2591",
            "fax_number": "313-822-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 KERCHEVAL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482142439",
            "telephone_number": "313-921-5500",
            "fax_number": "313-921-5530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DETROIT COMMUNITY HEALTH CONNECTION, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DETROIT COMMUNITY HEALTH CONNECTION, INC.",
        "enumeration_date": "2008-07-08",
        "last_updated": "2013-04-26",
        "status": "A",
        "authorized_official_last_name": "KAKARALA",
        "authorized_official_first_name": "MAHIPAL",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "SR VP/CFO",
        "authorized_official_telephone_number": "313-821-2591",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Sophie Womack Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.