NPIMap

Organization Active NPI

Vernon J Harris East End Community Health Center

Doing business as Capital Area Health Network - Henderson Health Services

  • Federally Qualified Health Center (FQHC)
  • Richmond, VA
National Provider Identifier
1366920530
Registry record updated Nov 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Doing business as
Capital Area Health Network - Henderson Health Services
Practice address
1500 N Lombardy St
Richmond, VA 23220-1711
Phone
(804) 780-0840
Fax
(804) 780-0862
NPI assigned
Jul 31, 2018
Last updated
Nov 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 17, 2022

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

Authorized official

Name
Mr. Tracy Causey, MSPH, MBA
Title
Ceo
Phone
(804) 253-1968

Specialties & licenses 1

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

Addresses

Primary practice location

1500 N Lombardy St
Richmond, VA 23220-1711

Mailing address

2809 North Ave
Richmond, VA 23222-3647
Phone (804) 780-0840

Other names 1

  • Capital Area Health Network - Henderson Health Services Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040217000877 VA Part B Supplier - Clinic/Group Practice 9638064850 Receives reassigned benefits from 49 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Chesterfield, VA; Richmond, VA
O20181130001418 VA Part A Provider - Federally Qualified Health Center (FQHC) 9638064850 Practice locations: Richmond, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366920530. Details of each certification follow.

Federally qualified health center certification: CCN 491965

Legal name
VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Mar 15, 1998 in VA
Enrollment address
1500 N Lombardy St
Richmond, VA 23220-1711

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 7

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

National Provider Directory

National Provider Directory
Tax ID family
Vernon J Harris East En5 organizations share this tax ID, including this one
Part of
Vernon J Harris East En

Other organizations with this tax ID 4

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

Locations

2740 Bensley Commons Blvd
North Chesterfield, VA 23237

1718 Williamsburg Rd
Richmond, VA 23231

2025 E Main St
Ste 105
Richmond, VA 23223
Phone (804) 253-1968

2711 Byron St
Richmond, VA 23223
Phone (804) 525-1818

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
Wilma Harris Individual Corporate DirectorMember Jul 24, 2012
Tracy Causey Individual Corporate Director Jan 13, 2003
Operational/Managerial Control Jan 13, 2003
Deone McWilliams Individual Corporate DirectorMember Apr 24, 2018
Michelle Hall Individual Corporate DirectorMember Feb 26, 2013
Betty Drummond Individual Corporate DirectorMember Jul 25, 2017
Joseph Lyons Individual Corporate DirectorMember Apr 24, 2018
Cynthia Evans Individual Corporate DirectorMember Apr 24, 2018
Darrell Johnson Individual Corporate DirectorTreasurer Oct 27, 2014
Denizez Moss Individual Corporate DirectorMember Apr 24, 2018
Anna Ruth Staton Individual Corporate DirectorSecretary Oct 16, 2009

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 56

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 56

NPI Registry JSON

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668643200000",
    "number": "1366920530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 NORTH AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232223647",
            "telephone_number": "804-780-0840",
            "fax_number": "804-329-1206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 N LOMBARDY ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232201711",
            "telephone_number": "804-780-0840",
            "fax_number": "804-780-0862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VERNON J HARRIS EAST END COMMUNITY HEALTH CENTER",
        "enumeration_date": "2018-07-31",
        "last_updated": "2022-11-17",
        "certification_date": "2022-11-17",
        "status": "A",
        "authorized_official_last_name": "CAUSEY",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "804-253-1968",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPH, MBA"
    },
    "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": "Capital Area Health Network - Henderson Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.