Active NPI
Peak Vista Community Health Centers
Doing business as Health Center at South Circle
- Federally Qualified Health Center (FQHC)
- Colorado Springs, CO
National Provider Identifier
1407211824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Federally Qualified Health Center (FQHC)
- Legal business name
- PEAK VISTA COMMUNITY HEALTH CENTERS
- Doing business as
- Health Center at South Circle
- Practice address
- 2864 S Circle Dr
Suite 450
Colorado Springs, CO 80906 - Phone
- (719) 632-5700
- Fax
- (719) 344-7867
- NPI assigned
- Dec 30, 2015
- Last updated
- Sep 12, 2018
- Organization subpart
- Yes
- Parent organization
- PEAK VISTA COMMUNITY HEALTH CENTERS
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tracy Narvet McManus
- Title
- Cfo
- Phone
- (719) 344-6188
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | CO | Primary | |
| Medical Physician Assistant | 363AM0700X |
Addresses
Primary practice location
2864 S Circle Dr
Suite 450
Colorado Springs, CO 80906
Mailing address
3205 N Academy Blvd
Suite 130
Colorado Springs, CO 80917
Phone (719) 632-5700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05638267 | Medicaid | CO | |
| 02105055 | Medicaid | CO |
Other names 1
- Health Center at South Circle
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1407211824. Details of each certification follow.
Federally qualified health center certification: CCN 061976
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- HEALTH CENTER AT SOUTH CIRCLE
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 29, 2017
- Last certification
- Jun 29, 2017
- Ownership / control type
- For profit – corporation
- Facility address
- 2864 South Circle Drive, Suite 450
Colorado Springs, CO 80906
National Provider Directory
National Provider Directory- Part of
- Community Health Ctr Co
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451433600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1536710400000",
"number": "1407211824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3205 N ACADEMY BLVD",
"address_2": "SUITE 130",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "80917",
"telephone_number": "719-632-5700",
"fax_number": "719-344-7865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2864 S CIRCLE DR",
"address_2": "SUITE 450",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "80906",
"telephone_number": "719-632-5700",
"fax_number": "719-344-7867"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PEAK VISTA COMMUNITY HEALTH CENTERS",
"enumeration_date": "2015-12-30",
"last_updated": "2018-09-12",
"status": "A",
"authorized_official_last_name": "MCMANUS",
"authorized_official_first_name": "TRACY",
"authorized_official_middle_name": "NARVET",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "719-344-6188"
},
"taxonomies": [
{
"code": "261QF0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
"state": "CO",
"license": null,
"primary": true
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05638267",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02105055",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Health Center at South Circle",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Health Center at South Circle",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Colorado Springs, CO
- Peak Vista Community Health Centers (Health Center at 340 Printers Parkway)
- Peak Vista Community Health Centers (Health Center at 155 Printers Pkwy St230)
- Peak Vista Community Health Centers (Mobile Health Services Van)
- Peak Vista Community Health Centers (Logan Health Center at Myron Stratton)
- Peak Vista Community Health Centers
- Peak Vista Community Health Centers (Health Center at Jet Wing)
- Peak Vista Community Health Centers (Springs Rescue Mission)
- Peak Vista Community Health Centers (Dental)
- Peak Vista Community Health Centers (Family Health Center at Mitchell High School)
- Peak Vista Community Health Centers (Health Center at Myron Stratton)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.