NPIMap

Organization Active NPI

Family Health Services of Darke County, Inc.

  • Federally Qualified Health Center (FQHC)
  • Union City, OH
National Provider Identifier
1306537121
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.
Practice address
10480 Staudt Rd
Union City, OH 45390-8648
Phone
(937) 968-5656
NPI assigned
May 15, 2023
Last updated
May 15, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Jared Pollick
Title
Executive Director
Phone
(937) 548-3806

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Student Health Clinic/Center 261QS1000X NU

Addresses

Primary practice location

10480 Staudt Rd
Union City, OH 45390-8648

Mailing address

5735 Meeker Rd
Greenville, OH 45331-1186

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231219001837 OH Part A Provider - Federally Qualified Health Center (FQHC) 5698762235 Practice locations: Union City, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306537121. Details of each certification follow.

Federally qualified health center certification: CCN D21028

Legal name
FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 11, 2023
Last certification
Dec 11, 2023
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 16, 1973 in OH
Enrollment address
10480 Staudt Rd
Union City, OH 45390-8648

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Family HLTH SVCS33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Locations

10480 Staudt Rd
Union City, OH 45390
Phone (937) 968-5656

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Crysta Bloomingdale Individual Corporate DirectorBoard Member Jul 30, 2018
Austie M Auker Individual Corporate DirectorFinance Director Jul 23, 2014 100%
W-2 Managing EmployeeFinance Director Jul 23, 2014 100%
Alan Ayette Individual Corporate DirectorBoard Member Jul 10, 2023
Michael Robert Maher Individual Corporate DirectorBoard Member Jul 31, 2017
Sonja Etzell Individual Corporate DirectorBoard Member Apr 25, 2015
Joy Greer Individual Corporate DirectorBoard Member Aug 5, 2019
Cassidy Helman Individual Corporate DirectorBoard Member Aug 1, 2022
Kathy S O'Dell Individual Corporate DirectorBoard Member Jun 23, 2014
Jared M Pollick Individual Corporate DirectorExecutive Director May 22, 2020 100%
W-2 Managing EmployeeExecutive Director May 22, 2020 100%
John Warner Individual Corporate DirectorBoard Member Aug 1, 2022
Thomas Treon Individual Corporate DirectorBoard Member Jul 30, 2018
Scott C Clum Individual Corporate DirectorBoard Member Jul 25, 2016

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Comprehensive Health NetworkGreenville, OH, CCN 367444 Home health agency 5% Or Greater Direct Ownership Interest May 19, 2009

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1306537121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5735 MEEKER RD",
            "city": "GREENVILLE",
            "state": "OH",
            "postal_code": "453311186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10480 STAUDT RD",
            "city": "UNION CITY",
            "state": "OH",
            "postal_code": "453908648",
            "telephone_number": "937-968-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH SERVICES OF DARKE COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "POLLICK",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "937-548-3806"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union City, OH

Sources for this page

Verify at the official NPI Registry.