Suncoast Community Health Centers, Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SUNCOAST COMMUNITY HEALTH CENTERS, INC

Doing business as

Brandon Community Health Center

Practice address

125 N Moon Ave
Suite a
Brandon, FL 33510-4431

Phone

(813) 643-6690

NPI assigned

Aug 1, 2011

Last updated

Aug 1, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert R Rodriguez

Title

Cfo

Phone

(813) 349-7563

Specialties & licenses 1

Addresses

Other names 1

• Brandon Community Health Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295013852. Details of each certification follow.

• CCN 101169 Federally qualified health center · Active · Details

Federally qualified health center certification: CCN 101169

Legal name

SUNCOAST COMMUNITY HEALTH CENTERS INC

Doing business as

BRANDON COMMUNITY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 6, 2014

Last certification

Aug 6, 2014

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Dec 14, 1977 in FL

Enrollment address

313 South Lakewood Dr
Brandon, FL 33511-2815

Other NPIs on the same Medicare enrollment 1

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

• Suncoast Community Health Centers, Inc

  dba Brandon Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Brandon, FL
  • NPI 1669830832

  O20140806000102

  Same enrollment

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.

Owners & managing parties with NPI records 2

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

• Aura Maria Cisneros, D.M.D

  • General Practice Dentistry
  • Ruskin, FL
  • NPI 1356346340

  Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership
• Brian Michael Shaub, D.O.

  • Family Medicine Physician
  • Dover, FL
  • NPI 1992817498

  Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

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

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312156800000",
    "number": "1295013852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "DOVER",
            "state": "FL",
            "postal_code": "335270040",
            "telephone_number": "813-643-6690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 N MOON AVE",
            "address_2": "SUITE A",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335104431",
            "telephone_number": "813-643-6690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNCOAST COMMUNITY HEALTH CENTERS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-01",
        "last_updated": "2011-08-01",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "813-349-7563"
    },
    "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": "Brandon Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Suncoast Community Health Centers, Inc (Brandon Community Health Center)

• Federally Qualified Health Center (FQHC) in Brandon, FL
• Providers in Brandon, FL by specialty
• Federally Qualified Health Center (FQHC) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.