NPIMap

Organization Active NPI

Suncoast Community Health Centers Inc

  • Federally Qualified Health Center (FQHC)
  • Ruskin, FL
National Provider Identifier
1285644799
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SUNCOAST COMMUNITY HEALTH CENTERS INC
Practice address
820 15TH St SE
Ruskin, FL 33570-5471
Phone
(813) 349-7800
Fax
(813) 349-7861
NPI assigned
Aug 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

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

Authorized official

Name
Susan Peltz, CFO
Title
Chief Financial Officer
Phone
(813) 349-7586

Specialties & licenses 1

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

Addresses

Primary practice location

820 15TH St SE
Ruskin, FL 33570-5471

Mailing address

13110 Elk Mountain Dr
Riverview, FL 33579-7182
Phone (813) 349-7567

Other identifiers 1

IdentifierTypeStateIssuer
029557400MedicaidFL

Other names 1

  • Ruskin Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030207000029 FL Part A Provider - Federally Qualified Health Center (FQHC) 3870402548 Practice locations: Ruskin, FL
O20040107000797 FL Part B Supplier - Clinic/Group Practice 3870402548 Receives reassigned benefits from 69 practitioners
Practice locations: Tampa, FL; Wimauma, FL; Thonotosassa, FL; Ruskin, FL; Riverview, FL; Plant City, FL; Lakeland, FL; Dover, FL…
O20260324000558 FL Part A Provider - Federally Qualified Health Center (FQHC) 3870402548 Practice locations: Ruskin, FL

Federally qualified health center certification: CCN 101916

Legal name
SUNCOAST COMMUNITY HEALTH CENTERS INC
Doing business as
RUSKIN HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 12, 1996
Last certification
Sep 12, 1996
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 1, 1977 in FL
Enrollment address
2814 14TH Ave SE
Ruskin, FL 33570-5471

Federally qualified health center certification: CCN C11077

Legal name
SUNCOAST COMMUNITY HEALTH CENTERS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 17, 2026
Last certification
Feb 17, 2026
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
820 15TH St SE
Ruskin, FL 33570-5132

Other NPIs with the same Medicare PAC ID 8

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

National Provider Directory

National Provider Directory

Locations

313 S Lakewood Dr
Brandon, FL 33511
Phone (813) 349-7900

801 E Baker St
#340B
Plant City, FL 33563

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Roberto Morales Individual Corporate OfficerCoo Jan 1, 2025
W-2 Managing EmployeeCoo Jan 1, 2025
Operational/Managerial ControlCoo Jan 1, 2025
Corporate OfficerCoo Mar 17, 2025
W-2 Managing EmployeeCoo Mar 17, 2025
Operational/Managerial ControlCoo Mar 17, 2025
Gwendolyn Smalley Individual Corporate DirectorBoard Member Sep 8, 2010
Corporate DirectorBoard of Directors Mar 17, 2025
Bradley Herremans Individual Corporate OfficerCeo Sep 8, 2010
W-2 Managing EmployeeAd; Sep 8, 2010
Operational/Managerial ControlCeo Sep 8, 2010
Corporate OfficerCeo Mar 17, 2025
W-2 Managing EmployeeAd; Mar 17, 2025
Operational/Managerial ControlCeo Mar 17, 2025
Nancy Hewlett Individual Corporate DirectorBoard Member Jan 1, 2025
Corporate DirectorBoard of Directors Mar 17, 2025
Brian Shaub Individual Corporate OfficerChief Medical Officer Jan 1, 2025
W-2 Managing EmployeeMD; Jan 1, 2025
Operational/Managerial ControlChief Medical Officer Jan 1, 2025
W-2 Managing EmployeeMD; Mar 17, 2025
Operational/Managerial ControlChief Medical Director Mar 17, 2025
Carlos Garcia Individual Corporate DirectorBoard Vice Chair Jan 1, 2025
Corporate DirectorBoard of Directors, Vice Chair Mar 17, 2025
Susan Peltz Individual Corporate OfficerCfo Jan 3, 2025
W-2 Managing EmployeeCfo Jan 3, 2025
Operational/Managerial ControlCfo Jan 3, 2025
Corporate OfficerCfo Mar 17, 2025
W-2 Managing Employee Mar 17, 2025
Operational/Managerial ControlCfo Mar 17, 2025
Elbert Odor Individual Corporate DirectorBoard Member Jan 1, 2025
Corporate DirectorBoard of Directors Mar 17, 2025
Nelson Ramos Individual Corporate DirectorBoard Member Sep 8, 2010
Corporate DirectorBoard of Directors Mar 17, 2025
Maria Consuela Huber Individual Corporate DirectorBoard Treasurer Jan 1, 2025
Corporate DirectorBoard of Directors, Treasurer Mar 17, 2025
Krystal Lockhart Individual Corporate DirectorBoard Secretary Jan 1, 2025
Corporate DirectorBoard of Directors, Secretary Mar 17, 2025
Ivon Ruz Individual Corporate DirectorBoard Member Jan 1, 2025
Corporate DirectorBoard of Directors Mar 17, 2025
Rich Glorioso Individual Corporate DirectorBoard Member Jan 1, 2025
Corporate DirectorBoard of Directors Mar 17, 2025
Dina M Bastian Individual W-2 Managing EmployeeBilling Manager Mar 17, 2025
Operational/Managerial ControlBilling Manager Mar 17, 2025
Aura M Cisneros Individual Corporate OfficerChief Dental Officer Mar 17, 2025
W-2 Managing EmployeeChief Dental Officer Mar 17, 2025
Operational/Managerial ControlChief Dental Officer Mar 17, 2025

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 83

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745452800000",
    "number": "1285644799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13110 ELK MOUNTAIN DR",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335797182",
            "telephone_number": "813-349-7567",
            "fax_number": "813-349-7596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 15TH ST SE",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335705471",
            "telephone_number": "813-349-7800",
            "fax_number": "813-349-7861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCOAST COMMUNITY HEALTH CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "PELTZ",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "813-349-7586",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029557400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ruskin Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ruskin, FL

Sources for this page

Verify at the official NPI Registry.