NPIMap

Organization Active NPI

Chase Brexton Health Services, Inc.

Doing business as Chase Brexton Health Care

  • Federally Qualified Health Center (FQHC)
  • Columbia, MD
National Provider Identifier
1376589309
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHASE BREXTON HEALTH SERVICES, INC.
Doing business as
Chase Brexton Health Care
Practice address
5500 Knoll North Dr
Ste 370
Columbia, MD 21045-2209
Phone
(410) 884-7831
Fax
(410) 715-3734
NPI assigned
Jun 20, 2006
Last updated
Apr 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Authorized official

Name
Mr. Kyle Easton
Title
Revenue Cycle Director
Phone
(410) 837-2050

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Mental Health Counselor 101YM0800X

Addresses

Primary practice location

5500 Knoll North Dr
Ste 370
Columbia, MD 21045-2209

Mailing address

1111 North Charles Street
Baltimore, MD 21201
Phone (410) 837-2050

Other identifiers 1

IdentifierTypeStateIssuer
132190100MedicaidMD

Other names 1

  • Chase Brexton Health Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060926000561 MD Part A Provider - Federally Qualified Health Center (FQHC) 5395644835 Practice locations: Columbia, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376589309. Details of each certification follow.

Federally qualified health center certification: CCN 211855

Legal name
CHASE BREXTON HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 28, 2006
Last certification
Sep 28, 2006
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1989 in MD
Enrollment address
5500 Knoll North Dr 370
Columbia, MD 21045-2393

Other NPIs with the same Medicare PAC ID 5

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

National Provider Directory

National Provider Directory

Locations

8221 Teal Dr
Ste 202
Easton, MD 21601
Phone (866) 260-0412

791 Aquahart Rd
Glen Burnie, MD 21061
Phone (410) 222-6838

8507 Liberty Rd
Randallstown, MD 21133
Phone (410) 496-9105

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Juan Negrin Individual Corporate DirectorBoard of Directors Jan 1, 2017 5%
Alaysia Phillips Individual Corporate DirectorBoard Jan 1, 2023 5%
Joe Ferlise Individual Corporate DirectorBoard Jan 1, 2021 5%
Patrick Mutch Individual Corporate OfficerCeo Mar 1, 2017 50%
W-2 Managing EmployeeCeo Mar 1, 2017 100%
Russell Montgomery Individual Corporate DirectorBoard Jan 1, 2021 5%
Rahul Gor Individual Corporate DirectorBoard of Directors Jan 1, 2017 5%
Oscar Franklin Individual Corporate DirectorBoard Jan 1, 2021 5%
Kaye Gooche Individual Corporate Director Jan 1, 2021 5%
Julia Krieger Individual Corporate DirectorBoard of Directors Jan 1, 2019 5%
Lois Anderson Individual Corporate DirectorBoard Jan 1, 2023 5%
Falayrium Burden Individual Corporate Director Jan 1, 2019 5%
Tina Jones Individual Corporate DirectorBoard Jan 1, 2022 5%
Damian Crawford Individual Corporate DirectorBoard of Directors Jan 1, 2016 5%
Neijma Celestine-Donnor Individual Corporate DirectorBoard Jan 1, 2023 5%
Eric Richard Turnbaugh Individual Corporate OfficerCfo Sep 16, 2019 25%
Jessica Obyan Individual Corporate DirectorBoard Jan 1, 2022 5%

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 204

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 204

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1376589309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 NORTH CHARLES STREET",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "21201",
            "telephone_number": "410-837-2050",
            "fax_number": "410-752-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 KNOLL NORTH DR",
            "address_2": "STE 370",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452209",
            "telephone_number": "410-884-7831",
            "fax_number": "410-715-3734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHASE BREXTON HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "EASTON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "REVENUE CYCLE DIRECTOR",
        "authorized_official_telephone_number": "410-837-2050",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "132190100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chase Brexton Health Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chase Brexton Health Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, MD

Sources for this page

Verify at the official NPI Registry.