NPIMap

Organization Active NPI

Universal Medical Services Inc

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
National Provider Identifier
1396395752
Registry record updated Feb 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNIVERSAL MEDICAL SERVICES INC
Practice address
3638 Central Ave NE
Minneapolis, MN 55418
Phone
(612) 345-5534
Fax
(612) 886-3929
NPI assigned
Sep 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2020

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

Authorized official

Name
Theodore James
Title
Ceo
Phone
(612) 823-2947

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3638 Central Ave NE
Minneapolis, MN 55418

Mailing address

3638 Central Ave NE
Minneapolis, MN 55418

Other names 1

  • Central Family Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200501000660 MN Part A Provider - Federally Qualified Health Center (FQHC) 9032283262 Practice locations: Minneapolis, MN

Federally qualified health center certification: CCN 241888

Legal name
UNIVERSAL MEDICAL SERVICES, INC
Doing business as
AXIS CENTRAL FAMILY CLINIC
Organization structure
CorporationNon-profit
Enrollment address
3638 Central Ave NE
Minneapolis, MN 55418-1343

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Universal Medical Services Inc Dbaaxis Medical Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Zillehuma Ebrahim Individual Corporate OfficerCoo Apr 1, 2019
W-2 Managing EmployeeCoo Apr 1, 2019
Crispin J Semakula Individual Corporate DirectorMedical Director Jan 1, 2022
Divine Arpellet Individual Corporate DirectorVice Board Chair Apr 16, 2022
Dan Loes Individual Corporate DirectorBoard Treasurer Jan 1, 2018
Birki Yousuf Individual Corporate DirectorBoard Member Nov 1, 2022
Theodore B James Individual Corporate OfficerCeo Nov 25, 2015
W-2 Managing Employee Nov 25, 2015
Gracious Msuya Individual Corporate DirectorBoard Chair Jan 1, 2023
Fred Adiyia Individual Corporate DirectorBoard Member Jan 1, 2018

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582675200000",
    "number": "1396395752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3638 CENTRAL AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3638 CENTRAL AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55418",
            "telephone_number": "612-345-5534",
            "fax_number": "612-886-3929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL MEDICAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-18",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "612-823-2947"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Central Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.