NPIMap

Organization Active NPI

Choptank Community Health System Inc

Doing business as Chestertown Health Center

  • Federally Qualified Health Center (FQHC)
  • Chestertown, MD
National Provider Identifier
1306580147
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Doing business as
Chestertown Health Center
Practice address
126 Philosophers Ter
Chestertown, MD 21620-1612
Phone
(410) 479-4306
Fax
(410) 479-1714
NPI assigned
Apr 27, 2022
Last updated
Apr 27, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CHOPTANK COMMUNITY HEALTH SYSTEM INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Authorized official

Name
Sara Rich
Title
Ceo
Phone
(410) 479-4306

Specialties & licenses 1

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

Addresses

Primary practice location

126 Philosophers Ter
Chestertown, MD 21620-1612

Mailing address

126 Philosophers Ter
Chestertown, MD 21620-1612
Phone (410) 479-4306

Other names 1

  • Chestertown Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220825000231 MD Part A Provider - Federally Qualified Health Center (FQHC) 0648189274 Practice locations: Chestertown, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306580147. Details of each certification follow.

Federally qualified health center certification: CCN 211940

Legal name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Doing business as
CHESTERTOWN HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 10, 2022
Last certification
Aug 10, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationProprietary
Incorporated
Jan 20, 1978 in MD
Enrollment address
126 Philosophers Ter
Chestertown, MD 21620-1612

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
Choptank Community Heal103 organizations share this tax ID, including this one
Part of
Choptank Community Heal

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Benjamin Cottle Individual Corporate OfficerCfo Jul 16, 2018
Jennifer W Yost Individual Corporate DirectorBoard Member Feb 1, 2015
Sara K Rich Individual Corporate OfficerCeo Jun 29, 2015
Rebecca Loukides Individual Corporate DirectorBoard Member Aug 1, 2016
Anna Sierra Individual Corporate DirectorBoard Member Feb 28, 2020
Savannah S Winston Individual Corporate DirectorBoard Member Feb 28, 2020
Sandra O'Neill Individual Corporate DirectorBoard Member May 23, 2019
Wayne Cole Individual Corporate DirectorBoard Member Jan 31, 2020
Matthew R Peters Individual Corporate DirectorBoard Member Apr 1, 2015
Lorenzo L Hughes Individual Corporate DirectorBoard Member Mar 25, 2019
Kimberly R Love Individual W-2 Managing EmployeeFinance Director Feb 22, 2002
Austin N Webster Individual Corporate DirectorBoard Member Jan 1, 2010
Sara B Visintainer Individual Corporate DirectorBoard Member Feb 1, 2015

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1651017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651017600000",
    "number": "1306580147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 PHILOSOPHERS TER",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216201612",
            "telephone_number": "410-479-4306",
            "fax_number": "410-479-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 PHILOSOPHERS TER",
            "city": "CHESTERTOWN",
            "state": "MD",
            "postal_code": "216201612",
            "telephone_number": "410-479-4306",
            "fax_number": "410-479-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHOPTANK COMMUNITY HEALTH SYSTEM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHOPTANK COMMUNITY HEALTH SYSTEM INC",
        "enumeration_date": "2022-04-27",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "RICH",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "410-479-4306"
    },
    "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": "Chestertown Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chestertown, MD

Sources for this page

Verify at the official NPI Registry.