NPIMap

Organization Active NPI

Third Street Community Clinic, Inc.

Doing business as Malabar Care Connect

  • Federally Qualified Health Center (FQHC)
  • Mansfield, OH
National Provider Identifier
1306499314
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
Malabar Care Connect
Practice address
205 W Cook Rd
Mansfield, OH 44907-2405
Phone
(419) 522-6191
Fax
(419) 525-6723
NPI assigned
Jul 18, 2019
Last updated
May 19, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

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

Authorized official

Name
Peggy Anderson
Title
Ceo
Phone
(419) 526-7880

Specialties & licenses 1

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

Addresses

Primary practice location

205 W Cook Rd
Mansfield, OH 44907-2405

Mailing address

1404 Park Ave W Ste 2
Ontario, OH 44906-2719
Phone (419) 522-6191

Other names 1

  • Malabar Care Connect Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191211000542 OH Part A Provider - Federally Qualified Health Center (FQHC) 2365423977 Practice locations: Mansfield, OH
O20200420003356 OH Part B Supplier - Clinic/Group Practice 2365423977 Receives reassigned benefits from 25 practitioners
Practice locations: Mansfield, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306499314. Details of each certification follow.

Federally qualified health center certification: CCN 721827

Legal name
THIRD STREET COMMUNITY CLINIC, INC.
Doing business as
MALABAR CARE CONNECT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 10, 2019
Last certification
Dec 10, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 18, 1994 in OH
Enrollment address
205 W Cook Rd
Mansfield, OH 44907-2405

Other NPIs with the same Medicare PAC ID 12

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Barbara Sullinger Individual Corporate OfficerCfo Aug 4, 2021
Corporate Director Aug 4, 2021
W-2 Managing EmployeeCfo Aug 4, 2021
James Dolan Individual Corporate DirectorBoard Member Dec 5, 2019
Dorothy Stratton Individual Corporate DirectorBoard Member Aug 4, 2021
Sheng Liu Individual Corporate DirectorCco Jan 10, 2023
W-2 Managing EmployeeCco Jan 10, 2023
Allen Hocker Individual Corporate DirectorBoard Member May 18, 2023
Douglas Newsome Individual Corporate DirectorBoard Member May 18, 2023
Joe Stafford Individual Corporate DirectorBoard Member Oct 19, 2023
Jalen Reese Individual Corporate DirectorBoard Member May 18, 2023
Brigitte Coles Individual Corporate DirectorBoard Member Oct 19, 2021
Kathy Wells Individual Corporate DirectorBoard Member Oct 19, 2023
Cindy Wetterau Individual Corporate DirectorBoard Member Oct 19, 2023
Khushwant Pittenger Individual Corporate DirectorBoard Member Aug 4, 2021
Julie Chaya Individual Corporate DirectorBoard Member Apr 21, 2022
Tom Walker Individual Corporate DirectorBoard Member Oct 19, 2023
Amber Wertman Individual Corporate DirectorBoard Member Aug 4, 2021
Cody Albert Individual Corporate DirectorBoard Member Aug 4, 2021
Peggy S Anderson Individual Corporate OfficerCeo Aug 4, 2021
Corporate DirectorBoard Member - P Aug 4, 2021
W-2 Managing EmployeeCeo Aug 4, 2021
Joe Devany Individual Corporate DirectorBoard Member Oct 19, 2023
Barrett Thomas Individual Corporate DirectorTreasurer Feb 16, 2023
Javar Jackson Individual Corporate OfficerCoo Aug 4, 2021
Corporate Director Aug 4, 2021
W-2 Managing EmployeeCoo Aug 4, 2021
Sally Gesouras Individual Corporate DirectorBoard Member Jan 18, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 26

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 26

NPI Registry JSON

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779148800000",
    "number": "1306499314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 PARK AVE W STE 2",
            "city": "ONTARIO",
            "state": "OH",
            "postal_code": "449062719",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W COOK RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449072405",
            "telephone_number": "419-522-6191",
            "fax_number": "419-525-6723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD STREET COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-18",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "419-526-7880"
    },
    "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": "Malabar Care Connect",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Malabar Care Connect",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mansfield, OH

Sources for this page

Verify at the official NPI Registry.