NPIMap

Organization Active NPI

Tri-State Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Hancock, MD
National Provider Identifier
1366491201
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TRI-STATE COMMUNITY HEALTH CENTER, INC
Practice address
130 W High St
Hancock, MD 21750-1143
Phone
(301) 678-5187
Fax
(301) 678-5797
NPI assigned
May 9, 2006
Last updated
Aug 3, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2010

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

Authorized official

Name
Mrs. Sheila J Deshong
Title
Executive Director
Phone
(301) 678-7256

Specialties & licenses 1

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

Addresses

Primary practice location

130 W High St
Hancock, MD 21750-1143

Mailing address

109 Rayloc Dr
Hancock, MD 21750-1518
Phone (301) 678-5187

Other identifiers 3

IdentifierTypeStateIssuer
0035061000MedicaidWV
482501200MedicaidMD
1723320/01MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000462 MD Part B Supplier - Clinic/Group Practice 9335057355 Receives reassigned benefits from 18 practitioners
2 other NPIs on this enrollment
Practice locations: Cumberland, MD; Hancock, MD
O20100813000835 MD Part A Provider - Federally Qualified Health Center (FQHC) 9335057355 Practice locations: Hancock, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366491201. Details of each certification follow.

Federally qualified health center certification: CCN 211809

Legal name
TRI-STATE COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 18, 1987 in MD
Enrollment address
130W High St
Hancock, MD 21750-1143

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 2

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
21D0220865Tri-State Community Health Center130 West High Street, Hancock, MD 21750Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Tri-State Community Health Center-Hosp Physicians Practice7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

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
Carolyn Lee Clingerman Individual Corporate DirectorBoard Member Aug 6, 2018
Nancy Forlifer Individual Corporate DirectorBoard Member Jun 6, 2011
Operational/Managerial ControlMember of Board of Directors Jun 6, 2011
Katherine Ann Salesky Individual Corporate DirectorBoard Member Jun 15, 2017
Sheila J Deshong Individual Corporate OfficerCoo Apr 14, 1996
W-2 Managing Employee Apr 15, 1996
Tracy Lynn Salvagno Individual Corporate Director Dec 1, 2008
Elen L Ott Individual Corporate DirectorVice-President - Board Oct 1, 2016
Savin Ramani Pillai Individual Corporate DirectorBoard Member Apr 2, 2018
Cordelia J Carson Individual Corporate DirectorSecretary - Board Oct 7, 2013
Susan B Walter Individual W-2 Managing EmployeeCeo Jul 5, 2011 100%
Satricia a Woodal Individual W-2 Managing EmployeeHR Manager Jul 19, 2004
Terry Lee Beeman Individual Corporate DirectorBoard Member Oct 7, 2019
Richard Strait Individual Corporate DirectorTreasurer - Board Apr 1, 2007
William Britton Garlitz Individual Corporate DirectorBoard Member Mar 4, 2019
Pamela Jean Sauter Mann Individual Corporate DirectorBoard Member Sep 9, 2019

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280793600000",
    "number": "1366491201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 RAYLOC DR",
            "city": "HANCOCK",
            "state": "MD",
            "postal_code": "217501518",
            "telephone_number": "301-678-5187",
            "fax_number": "301-678-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W HIGH ST",
            "city": "HANCOCK",
            "state": "MD",
            "postal_code": "217501143",
            "telephone_number": "301-678-5187",
            "fax_number": "301-678-5797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "DESHONG",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-678-7256",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0035061000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "482501200",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1723320/01",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hancock, MD

Sources for this page

Verify at the official NPI Registry.