NPIMap

Choptank Community Health System Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Chestertown, MD

NPI 1306580147 · NPPES record last updated Apr 27, 2022

Key facts

NPI
1306580147
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
CHOPTANK COMMUNITY HEALTH SYSTEM INC
Practice address
126 Philosophers Ter
Chestertown, MD 21620-1612
Phone
(410) 479-4306
Fax
(410) 479-1714
NPI assigned
Apr 27, 2022
Organization subpart
Yes
Parent organization (as reported)
CHOPTANK COMMUNITY HEALTH SYSTEM INC

Authorized official

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

Owners & managing parties with NPI records 1

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

Other NPIs with the same Medicare PAC ID 11

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

Corporate family (same tax ID) 24

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

Practitioners 40

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

View all 40

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MD

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
Corporation · Proprietary
Incorporated
Jan 20, 1978 in MD
Enrollment address
126 Philosophers Ter
Chestertown, MD 21620-1612

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

Medicare enrollment records

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

National Provider Directory

Tax ID family
Choptank Community Health System Inc (103 organizations share this tax ID)
Part of
Choptank Community Health System Inc

Specialties & licenses

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

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

  • Chestertown Health Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 27, 2022.

{
    "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

All providers in Chestertown, MD · Federally Qualified Health Center (FQHC) in Maryland

Sources for this page

Verify at the official NPI Registry.