NPIMap

Organization Active NPI

Christ Community Health Services Inc

  • Federally Qualified Health Center (FQHC)
  • Memphis, TN
National Provider Identifier
1407017650
Registry record updated Dec 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CHRIST COMMUNITY HEALTH SERVICES INC
Practice address
2569 Douglass Ave
Christ Community Health Services, Inc
Memphis, TN 38114-2532
Phone
(901) 271-6200
Fax
(901) 271-6249
NPI assigned
Jun 20, 2008
Last updated
Dec 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2024

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

Authorized official

Name
Tracy McDaniel
Title
Ceo
Phone
(901) 842-3160

Specialties & licenses 1

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

Addresses

Primary practice location

2569 Douglass Ave
Christ Community Health Services, Inc
Memphis, TN 38114-2532

Mailing address

2670 Union Avenue Ext Ste 1000
Memphis, TN 38112-4416
Phone (901) 842-3160

Other identifiers 2

IdentifierTypeStateIssuer
3707256OtherTNMEDICAID GROUP NUMBER
3707256OtherTNMEDICARE GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040528000468 TN Part B Supplier - Clinic/Group Practice 3870402084 Receives reassigned benefits from 100 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Memphis, TN; Jackson, TN
O20060720000244 TN Part A Provider - Federally Qualified Health Center (FQHC) 3870402084 1 other NPI on this enrollment
Practice locations: Memphis, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407017650. Details of each certification follow.

Federally qualified health center certification: CCN 441905

Legal name
CHRIST COMMUNITY HEALTH SERVICES INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 18, 2006
Last certification
Aug 18, 2006
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2003 in TN
Enrollment address
2569 Douglass Ave
Memphis, TN 38114-2532

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Christ Community Health Services Inc23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Rebecca Kernan Individual Corporate DirectorBoard Member May 1, 2013
John M Drake Individual Corporate OfficerPresident Apr 1, 2026
Corporate DirectorDirector Apr 1, 2026
W-2 Managing EmployeeCeo Apr 1, 2026
Norma L Hunt Individual Corporate OfficerBoard Secretary May 1, 2013
Corporate DirectorBoard Member May 1, 2013
Florence Jones Individual Corporate DirectorBoard Jun 4, 2024
Jerry Gay Individual Corporate OfficerBoard Vice Chair Aug 1, 2024
Corporate DirectorVice Chair Aug 1, 2024
Reginique Green Individual W-2 Managing EmployeeChief Clinical Officer Jan 5, 2015
Kirk Bailey Individual Corporate DirectorBoard Member May 1, 2013
Carol Jackson Individual Corporate DirectorBoard Aug 1, 2024
John Ross Dyer Individual Corporate OfficerBoard Chair May 1, 2013
Corporate DirectorBoard Member May 1, 2013
Carlos Martin Individual Corporate DirectorBoard Aug 1, 2024
Kimberly Young Individual Corporate DirectorBoard Aug 1, 2024
Angela Rogers Individual Corporate DirectorBoard Aug 1, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1213920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733443200000",
    "number": "1407017650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 UNION AVENUE EXT STE 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381124416",
            "telephone_number": "901-842-3160",
            "fax_number": "901-260-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2569 DOUGLASS AVE",
            "address_2": "CHRIST COMMUNITY HEALTH SERVICES, INC",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381142532",
            "telephone_number": "901-271-6200",
            "fax_number": "901-271-6249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRIST COMMUNITY HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-20",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "901-842-3160"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP NUMBER",
            "identifier": "3707256",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "3707256",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.