NPIMap

Organization Active NPI

Circle the City

Doing business as Circle the City Medical Respite Center, Downtown Campus

  • Federally Qualified Health Center (FQHC)
  • Phoenix, AZ
National Provider Identifier
1346755295
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CIRCLE THE CITY
Doing business as
Circle the City Medical Respite Center, Downtown Campus
Practice address
210 S 12TH Ave
Phoenix, AZ 85007-3101
Phone
(602) 776-9000
Fax
(602) 776-9001
NPI assigned
Dec 13, 2017
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
William Ellert, MDNPI 1861449167
Title
Chief Medical Officer
Phone
(602) 776-0776

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

210 S 12TH Ave
Phoenix, AZ 85007-3101

Mailing address

300 W Clarendon Ave Ste 200
Phoenix, AZ 85013-3422
Phone (602) 776-0776

Other names 1

  • Circle the City Medical Respite Center, Downtown Campus Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150609001984 AZ Part B Supplier - Clinic/Group Practice 3971824442 Receives reassigned benefits from 68 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Phoenix, AZ
O20181130001999 AZ Part A Provider - Federally Qualified Health Center (FQHC) 3971824442 Practice locations: Phoenix, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346755295. Details of each certification follow.

Federally qualified health center certification: CCN 031978

Legal name
CIRCLE THE CITY
Doing business as
CIRCLE THE CITY MEDICAL RESPITE CENTER, DOWNTOWN CAMPUS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 30, 2018
Last certification
Nov 30, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 11, 2008 in AZ
Enrollment address
210 S 12TH Ave
Phoenix, AZ 85007-3101

Other NPIs with the same Medicare PAC ID 6

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2151280Circle the City Downtown Respite Center210 S 12TH Ave, Phoenix, AZ 85007Certificate of waiverJul 16, 2028

National Provider Directory

National Provider Directory

Locations

210 S 12th Ave
Phoenix, AZ 85007
Phone (602) 254-4282

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
James T Nathan Individual Corporate DirectorDirector Oct 24, 2016
Kelli Kathleen Smith Individual Corporate DirectorDirector Jan 1, 2024
Roy Pringle Individual Corporate DirectorTreasurer Oct 24, 2016
Michael Zenobi Individual Corporate OfficerChief Administrative Officer Jan 1, 2024
W-2 Managing EmployeeChief Administrative Officer Jan 1, 2024
Operational/Managerial ControlChief Administrative Officer Jan 1, 2024
Circle the City Organization, Phoenix, AZ Non-profit 5% Or Greater Direct Ownership Interest Jan 2, 2018 100%
Operational/Managerial Control Jan 2, 2018 100%
John Moore Individual Corporate OfficerChief Financial Officer Jan 1, 2024
W-2 Managing EmployeeChief Financial Officer Jan 1, 2024
Operational/Managerial ControlChief Financial Officer Jan 1, 2024
Thomas Betlach Individual Corporate DirectorDirector Jan 1, 2024
Marc L Leib Individual Corporate DirectorDirector Oct 24, 2016
Kathy Stein Individual Corporate DirectorDirector May 22, 2017
Jeffrey Smith Individual Corporate DirectorDirector Jan 1, 2024
Lori Ann McClelland Individual Corporate DirectorDirector Sep 27, 2010
Danielle Millard Individual Corporate DirectorDirector Jan 1, 2024
Jaxinta Shaffer Individual Corporate DirectorDirector Jan 1, 2024
Marion K. Kelly Individual Corporate DirectorDirector Oct 24, 2016

Owners & managing parties with NPI records 6

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

  • Circle the City

    dba Circle the City Pharmacy

    • Community/Retail Pharmacy
    • Phoenix, AZ
    • NPI 1144093972

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Circle the City
    • Family Medicine Physician
    • Phoenix, AZ
    • NPI 1346588316

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Circle the City

    dba Circle the City Family Health Center - UMOM Campus

    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1447765474

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1487033247

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Circle the City

    dba Circle the City Family Health Center, Downtown Campus

    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1548775570

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1932588795

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Parsons Family Health Center at Circle the CityPhoenix, AZ, CCN 031926 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jun 12, 2015
Circle the City Family Health Center, Downtown CampusPhoenix, AZ, CCN 031970 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018

Owned or controlled facilities with NPI records 4

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

  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1487033247

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City

    dba Circle the City Family Health Center, Downtown Campus

    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1548775570

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1679954184

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Circle the City

    dba Circle the City Mobile Clinic II

    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1952948804

    5% Or Greater Direct Ownership Interest

    CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Circle the City
    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1487033247

    Circle the City

    CMS ownership
  • Circle the City

    dba Circle the City Family Health Center, Downtown Campus

    • Federally Qualified Health Center (FQHC)
    • Phoenix, AZ
    • NPI 1548775570

    Circle the City

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1513123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1346755295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W CLARENDON AVE STE 200",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850133422",
            "telephone_number": "602-776-0776",
            "fax_number": "602-705-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S 12TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850073101",
            "telephone_number": "602-776-9000",
            "fax_number": "602-776-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIRCLE THE CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-13",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "ELLERT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "602-776-0776",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Circle the City Medical Respite Center, Downtown Campus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.