NPIMap

Organization Active NPI

Premier Community Healthcare Group, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brooksville, FL
National Provider Identifier
1306377643
Registry record updated Mar 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PREMIER COMMUNITY HEALTHCARE GROUP, INC.
Practice address
300 S Main St
Brooksville, FL 34601-3320
Phone
(352) 518-2000
Fax
(352) 567-0218
NPI assigned
Mar 27, 2017
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Joseph Resnick
Title
Ceo
Phone
(352) 518-2000

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 9

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

Practitioners 10

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170605001715 FL Part a Provider - Federally Qualified Health Center (FQHC) 3476450818 Practice locations: Brooksville, FL

Federally qualified health center certification: CCN 681095

Medicare enrollment files
Legal name
PREMIER COMMUNITY HEALTH CARE GROUP INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 5, 2017
Last certification
Jun 5, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 29, 1979 in FL
Enrollment address
300 S Main St
Brooksville, FL 34601-3320

All disclosed owners & managing parties 1

Medicare enrollment files

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

NameRoleSinceShare
Joseph Resnick Individual 5% Or Greater Indirect Ownership InterestCeo Aug 22, 2014 100%
Corporate OfficerCeo Aug 22, 2014 100%
W-2 Managing EmployeeCeo Aug 22, 2014 100%

All facility ownership & control disclosures 2

Medicare enrollment files

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

FacilityTypeRoleSince
Premier Community Health Care Group IncNew Port Richey, FL, CCN 101042 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2009
Premier Community Health Care Group IncZephyrhills, FL, CCN 681144 Federally qualified health center Operational/Managerial Control (100%) Apr 1, 2019

National Provider Directory

National Provider Directory
Tax ID family
Healthresource Alliance20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

14410 Cobra Way
Hudson, FL 34669
Phone (727) 774-4264

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

300 S Main St
Brooksville, FL 34601-3320

Mailing address

PO Box 232
Dade City, FL 33526-0232
Phone (352) 518-2000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 27, 2017.

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1306377643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335260232",
            "telephone_number": "352-518-2000",
            "fax_number": "352-567-0218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S MAIN ST",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346013320",
            "telephone_number": "352-518-2000",
            "fax_number": "352-567-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER COMMUNITY HEALTHCARE GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-27",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "RESNICK",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "352-518-2000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooksville, FL

Sources for this page

Verify at the official NPI Registry.