NPIMap

Organization Active NPI

Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • West Valley City, UT
National Provider Identifier
1326417445
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTERS, INC.
Practice address
4535 S 5600 W
West Valley City, UT 84120-4639
Phone
(801) 676-4405
Fax
(877) 497-4661
NPI assigned
Sep 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Jennifer Thomas
Title
Executive Director
Phone
(801) 412-6920

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

4535 S 5600 W
West Valley City, UT 84120-4639

Mailing address

1455 W 2200 S Ste 300
West Valley City, UT 84119-7219
Phone (801) 412-6920

Other identifiers 1

IdentifierTypeStateIssuer
1326417445MedicaidUT

Other names 2

  • Ellis R. Ship Medical Clinic Doing business as
  • Ellis R. Shipp Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040203000767 UT Part B Supplier - Clinic/Group Practice 5991698169 Receives reassigned benefits from 66 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: West Valley City, UT; Tremonton, UT; Taylorsville, UT; Salt Lake City, UT; Midvale, UT; Brigham City, UT
O20160204001354 UT Part A Provider - Federally Qualified Health Center (FQHC) 5991698169 Practice locations: West Valley City, UT

Federally qualified health center certification: CCN 461854

Legal name
COMMUNITY HEALTH CENTERS INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 8, 2016
Last certification
Mar 8, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
4535 S 5600 W
West Valley City, UT 84120-4639

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1365 W 1000 N
Slc, UT 84116
Phone (801) 328-5750

2621 S 3270 W
Ste A
West Valley City, UT 84119

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Linda Stearns Individual Corporate DirectorBoard Member Nov 16, 2017
Keith O Horwood Individual W-2 Managing EmployeeAssociate Medical Director Jul 17, 1989
Lilli E Decair Individual Corporate DirectorBoard Member Oct 24, 2013
Jennifer Thomas Individual W-2 Managing EmployeeExecutive Director Mar 11, 2022 100%
Rachel L Hooley Individual Corporate DirectorBoard Secretary Dec 17, 2015
Susan C Johnston Individual Corporate DirectorBoard Treasurer Jul 29, 2010
Sheila M Hassett Individual Corporate DirectorBoard Member Feb 26, 2015
Gerry Ann Marty Individual Corporate DirectorBoard Member Aug 27, 2015
William Henrick Nelson Individual Corporate DirectorBoard President Dec 18, 2014
Robert L Bunnell Individual Corporate DirectorBoard Member Aug 23, 2012

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1442534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1326417445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 W 2200 S STE 300",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841197219",
            "telephone_number": "801-412-6920",
            "fax_number": "877-497-4661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4535 S 5600 W",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841204639",
            "telephone_number": "801-676-4405",
            "fax_number": "877-497-4661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTERS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-18",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-412-6920"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326417445",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ellis R. Ship Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellis R. Shipp Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ellis R. Shipp Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Valley City, UT

Sources for this page

Verify at the official NPI Registry.