NPIMap

Organization Active NPI

My Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Magnolia, OH
National Provider Identifier
1306495312
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MY COMMUNITY HEALTH CENTER
Practice address
10029 Cleveland Ave. SE
Magnolia, OH 44643
Phone
(234) 386-0306
Fax
(234) 386-0106
NPI assigned
Sep 11, 2019
Last updated
Mar 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

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

Authorized official

Name
Terry Regula
Title
Ceo
Phone
(330) 363-3179

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

10029 Cleveland Ave. SE
Magnolia, OH 44643

Mailing address

2600 7TH St SW
Canton, OH 44710-1709
Phone (330) 363-2218

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20170111003340 OH Part B Supplier - Clinic/Group Practice 3971884636 Receives reassigned benefits from 45 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Canton, OH; Magnolia, OH
O20191209000654 OH Part A Provider - Federally Qualified Health Center (FQHC) 3971884636 Practice locations: Magnolia, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306495312. Details of each certification follow.

Federally qualified health center certification: CCN 721826

Legal name
MY COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 2, 2019
Last certification
Dec 2, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 11, 2016 in OH
Enrollment address
10029 Cleveland Ave SE
Magnolia, OH 44643-9781

Other NPIs with the same Medicare PAC ID 3

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
My Community Health Center4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

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
Stewart Lytle Individual Corporate OfficerBoard Member Sep 23, 2024
Carol Johnson Individual Corporate DirectorBoard Member Feb 27, 2023
Maria Heige Individual Corporate DirectorBoard Member Sep 1, 2016
My Community Health Center Organization, Canton, OH Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2020 100%
Carl T Schleich Individual Corporate DirectorBoard Member Oct 23, 2023
Juan Paulo Afable Individual Corporate OfficerCeo Nov 7, 2022
W-2 Managing EmployeeCeo Nov 7, 2022
Maureen Ater Individual Corporate DirectorBoard Member Jan 1, 2021
Arelene Stinson Individual Corporate DirectorBoard Member Mar 25, 2024
Brenda White-Rogers Individual Corporate DirectorBoard Member Jan 22, 2024
Kelly Lorenz Individual Corporate OfficerChief Financial Officer (Cfo) Jul 1, 2019
W-2 Managing EmployeeChief Financial Officer (Cfo) Jul 1, 2019
Philip Mickley Individual Corporate DirectorBoard Member Jan 16, 2023
Susan E Mercer Individual Corporate DirectorBoard Member Sep 1, 2018
Thomas Casey Individual Corporate DirectorBoard Member Apr 25, 2022
Kevin Smith Individual Corporate DirectorBoard Member Jan 1, 2021
Thom Kalb Individual Corporate DirectorBoard Member Jul 22, 2024

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1568160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583971200000",
    "number": "1306495312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 7TH ST SW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447101709",
            "telephone_number": "330-363-2218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10029 CLEVELAND AVE. SE",
            "city": "MAGNOLIA",
            "state": "OH",
            "postal_code": "44643",
            "telephone_number": "234-386-0306",
            "fax_number": "234-386-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-11",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "REGULA",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-363-3179"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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 Magnolia, OH

Sources for this page

Verify at the official NPI Registry.