NPIMap

Organization Active NPI

Choptank Community Health System Inc

Doing business as St. Clair Head Start Dental Services

  • Federally Qualified Health Center (FQHC)
  • Cambridge, MD
National Provider Identifier
1316617954
Registry record updated Sep 15, 2021
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
St. Clair Head Start Dental Services
Practice address
824 Fairmount Ave
Cambridge, MD 21613-2150
Phone
(410) 479-4306
Fax
(410) 479-1714
NPI assigned
Sep 15, 2021
Last updated
Sep 15, 2021By 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 Sep 15, 2021

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

824 Fairmount Ave
Cambridge, MD 21613-2150

Mailing address

824 Fairmount Ave
Cambridge, MD 21613-2150
Phone (410) 479-4306

Other names 1

  • St. Clair Head Start Dental Services Doing business as

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

Locations

824 Fairmount Ave
Cambridge, MD 21613

NPI Registry JSON

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

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631664000000",
    "number": "1316617954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 FAIRMOUNT AVE",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216132150",
            "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": "824 FAIRMOUNT AVE",
            "city": "CAMBRIDGE",
            "state": "MD",
            "postal_code": "216132150",
            "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": "2021-09-15",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-01",
        "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": "St. Clair Head Start Dental Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cambridge, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.